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Do Personal Medical Services contracts improve quality of care? A multi-method evaluation
- Source :
- Journal of Health Services Research and Policy. 10:31-39
- Publication Year :
- 2005
- Publisher :
- SAGE Publications, 2005.
-
Abstract
- Objectives To assess whether the new contractual arrangements of first-wave Personal Medical Services (PMS) practices in England improved their quality of care, compared with changes in care provided in a control sample of General Medical Services (GMS) practices. Methods Controlled ‘before’ (at or near 1 April 1998) and ‘after’ (at or near 31 March 2001) quantitative observational study in a sample of 23 PMS and 23 GMS practices. Quantitative data focused on access, chronic disease management, mental health care, primary care of older people, costs and patient evaluation using the General Practice Assessment Survey. Case studies were also undertaken in all PMS pilots, involving interviews with general practitioners, nurses, practice managers and Health Authority and Primary Care Group/Trust managers, documentation review, and analysis of site-specific data. Results There were improvements in quality of care in PMS sites in all areas of care evaluated, but improvements in care over and above those found in GMS sites (the ‘PMS effect') were only statistically significant for angina care (P =0.05) and elderly care (P =0.04). Teamwork, shared culture, clear objectives and leadership were important catalysts for quality improvement in PMS sites. Improvements in PMS practices came at additional financial cost. There were concurrent improvements in GMS practices. No PMS site succeeded in meeting its aims without successfully introducing effective leadership and management, and changing relationships within the practice (e.g. equalising power between nurses and doctors). Conclusions Small but steady improvements were observed in English primary care. PMS contracts facilitated quality improvements in specific areas over and above these broad improvements (the ‘PMS effect') during the study period. New contractual arrangements for health care can be used to improve quality of care. However, the mechanisms that resulted in quality gains, while facilitated by the new contractual arrangements, were not specific or unique to the PMS experiment. Factors such as effective management, clear objectives and flexible professional relationships within practices are likely to be important in determining whether new contractual arrangements result in improved outcomes. The context within which care and services are provided is as important for quality innovations as specific contractual arrangements.
- Subjects :
- Quality management
media_common.quotation_subject
Context (language use)
Pilot Projects
General medical services
Health Services Accessibility
State Medicine
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
Nursing
Surveys and Questionnaires
Health care
Medicine
Humans
Quality (business)
030212 general & internal medicine
Disease management (health)
media_common
Quality of Health Care
Teamwork
Primary Health Care
business.industry
030503 health policy & services
Health Policy
Public Health, Environmental and Occupational Health
Disease Management
United Kingdom
Chronic Disease
Observational study
0305 other medical science
business
Subjects
Details
- ISSN :
- 13558196
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of Health Services Research and Policy
- Accession number :
- edsair.doi.dedup.....15304daf04525b7200889e9f2bdb575c