Are formalised implementation activities associated with aspects of quality of care in general practice? A cross-sectional study

Jette V Le; Jesper Lykkegaard; Line B Pedersen; Helle Riisgaard; Jørgen Nexøe; Jeanette Lemmergaard; Jens Søndergaard

doi:10.3399/bjgpopen17X100737

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Figure 1. Flowchart of the study population.
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Figure 2. Variation in spirometry proportion among general practices.

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Box 1. How domains in the questionnaire were operationalised into explaining variables in the analyses

Domains	Items	Description	Dichotomisation
Meeting structure	Scheduled meetings	The occurrence of scheduled meetings (versus ad hoc conversations)	Scheduled meetings: Yes/no
	Interdisciplinary meetings	Frequency of GP and staff meetings: Weekly/monthly/quarterly/rarer/never	Weekly: Yes/no
	GP meetings	Frequency of sole GP meetings: Weekly/monthly/quarterly/rarer/never	Weekly: Yes/no
	Educational meetings	Frequency of meetings aimed at learning about a specific topic: Weekly/monthly/quarterly/rarer/never	Weekly: Yes/no
	Formalised meetings	A formal agreement about agenda, mediator and/or minutes in relation to meetings. For each factor is stated: Always/often/sometimes/rarely/never	Always for all factors: Yes/no
Standardised processes of care	Practice protocols	The extent to which practice protocols are developed in the practice: In a range of areas of disease/in a few areas of disease/none at all	In a range of areas of disease: Yes/no
	Standard laboratory requisition formulas	The extent to which standard laboratory requisitions formulas are developed in the practice: In a range of areas of disease/in a few areas of disease/none at all	In a range of areas of disease: Yes/no
	Standard phrases in the EMR	The extent to which standard phrases in the EMR are developed in the practice: In a range of areas of disease/in a few areas of disease/none at all	In a range of areas of disease: Yes/no
Task differentiation among GPs	Responsibilities for medical update	The extent to which responsibilities regarding medical update (on for instance COPD, DM and IHD) are based on a formal agreement in the practice: yes/informal/no	Formal agreement: Yes/no

COPD = chronic obstructive pulmonary disease. DM = diabetes mellitus. EMR = electronic medical record. IHD = ischemic heart disease.

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Table 1. Distribution of implementation activities in single-handed and partnership practices

	Single-handed, n (%)	Partnership, n (%)	P-value^a
Meeting structure
Scheduled meetings — Yes	249 (60.4)	544 (92.4)	<0.001
Interdisciplinary meetings — Weekly	41 (16.6)	161 (29.6)	<0.001
GP meetings^b — Weekly	30 (25.2)	243 (44.7)	<0.001
Educational meetings — Weekly	37 (15.0)	101 (18.6)	0.220
Formalised meetings — Yes	55 (22.3)	211 (38.8)	<0.001
Standardised processes of care
Practice protocols — In a range of disease areas	153 (37.5)	394 (67.0)	<0.001
Standard laboratory requisition formulas — In a range of disease areas	219 (53.7)	473 (80.4)	<0.001
Standard recordings in the EMR — In a range of disease areas	131 (32.1)	303 (51.5)	<0.001
Task differentiation among GPs
Formal agreement^b — Yes	30 (19.4)		<0.001

↵ ^aCalculated using χ². ^bGPs in single-handed practices were only asked these questions if they had reported being in collaboration with other practices. EMR = electronic medical record.

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Table 2. Associations between implementation activities and patients having spirometry performed

	Single-handed		Partnership
	n (%)	OR adjusted (95% CI)	n (%)	OR adjusted (95% CI)
Meeting structure
Scheduled meetings No Yes	1296 (49.6) 2343 (54.5)	1 1.09 (0.89 to 1.33)	796 (54.1) 12 671 (55.3)	1 1.00 (0.82 to 1.22)
Interdisciplinary meetings Monthly or rarer Weekly	1903 (53.2) 423 (60.3)	1 1.20 (0.89 to 1.61)	8863 (54.8) 3808 (56.7)	1 1.12 (1.00 to 1.25)^b
GP meetings^a Monthly or rarer Weekly	801 (51.0) 285 (56.2)	1 1.40 (1.00 to 1.96)	6773 (53.6) 5898 (57.4)	1 1.15 (1.04 to 1.27)^b
Educational meetings Monthly or rarer Weekly	1924 (53.9) 402 (57.0)	1 1.06 (0.79 to 1.43)	9928 (54.8) 2743 (57.6)	1 1.05 (0.92 to 1.20)
Formalised meetings No Yes	1817 (54.8) 509 (52.9)	1 0.85 (0.65 to 1.10)	6998 (55.1) 5673 (55.7)	1 1.00 (0.90 to 1.11)
Standardised processes of care
Practice protocols Few/none at all In a range of disease areas	2100 (50.5) 1481 (55.3)	1 1.13 (0.93 to 1.37)	3670 (50.3) 9783 (57.4)	1 1.29 (1.15 to 1.43)^c
Standard laboratory requisition formulas Few/none at all In a range of disease areas	1459 (48.5) 2122 (55.4)	1 1.28 (1.06 to 1.55)^b	2054 (52.7) 11 399 (55.8)	1 1.13 (0.99 to 1.29)
Standard recordings in the EMR Few/none at all In a range of disease areas	2324 (51.3) 1257 (54.6)	1 1.02 (0.84 to 1.25)	6017 (53.6) 7436 (56.7)	1 1.14 (1.03 to 1.26)^b
Task differentiation among GPs
Formal agreement^a Informal/no Yes	1073 (50.7) 296 (49.7)	1 0.99 (0.71 to 1.39)	7795 (54.1) 5658 (56.9)	1 1.10 (1.00 to 1.23)

ORs are adjusted for practice characteristics (GPs’ age and sex, status as training practice, task delegation to practice staff) and patient characteristics (age, sex, income, highest attained education, labour market affiliation, cohabitation status, and severity of disease).
↵ ^aGPs in single-handed practices were only asked these questions if they had reported being in collaboration with other practices. ^b P<0.05. ^c P<0.001. EMR = electronic medical record. OR = odds ratio.