Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
PEI, CARE and CQI-2
- John GR Howie, Margaret Maxwell, David Heaney, George Freeman, Stewart Mercer (12 August 2007)
|
|
|||
|
John GR Howie, emeritus professor University of Edinburgh EH8 9DX, Margaret Maxwell, David Heaney, George Freeman, Stewart Mercer
Send e-letter to journal:
|
Dear Sir Assessing the practising physician using patient surveys: a systematic review of instruments and feedback methods Richard G Evans et al Family Practice 24 April 2007 p117-127 We enjoyed reading this thorough and informative review which will undoubtedly become a key reference paper in this important field. We were, however, somewhat disappointed that although our work on various relevant instruments including the Patient Enablement Instrument (PEI), the CARE Measure, and two versions of the Consultation Quality Instrument (CQI and CQI-2) was referred to in the review, these instruments were excluded from subsequent in-depth analyses. The main reason stated for the exclusion was that we had not provided evidence of individual performance feedback. In fact, all our researches on the PEI and CQI over the last two decades into the 'distribution and determinants of good quality care at consultations’ have included feedback to our collaborating doctors, and the references quoted by Evans et al do actually refer to this. Additionally, in an unreferenced project, an attempt to provide support services to practices with partnership or administrative problems included the use of PEI scores and was followed by often significant changes to partnership structure (1,2). And in another project comparing doctors’ opinions of the usefulness and acceptability of two of our measures (one the CQI), doctors expressed general approval of the methods we had used to study their consulting behaviour (3). In the case of the CARE Measure, which is a newer instrument, less formal data exists on the helpfulness of feedback but individual feedback, including factors that may relate to low scores, has been given to all doctors taking part in all studies. Since 2003 the CARE Measure (like the PEI) has been accredited for use in GP Appraisal by RCGP Scotland and NHS Education Scotland. GPs using the CARE Measure for Appraisal have been given personal feedback, and benchmarking by SWM when requested, and RCGP Scotland now offers a CARE Measure feedback service which gives benchmarking and advice(4). By omitting our work from their main analyses, the authors may have unintentionally reduced the chances of our being able to influence the development of work in this field in general, and specifically the evolution of the Quality and Outcomes Framework (QOF), which in our view significantly under-represents the importance of interpersonal care as part of the overall enterprise of general practice care (5). Although accepting Evans’ general conclusion that for all the instruments studied more work needs to be done we believe that through the evolution of PEI to CQI, and the addition of the CARE Measure to form CQI- 2 we have developed a robust instrument of at least comparable utility to those they reported on in depth. Yours sincerely John Howie ,Margaret Maxwell ,David Heaney ,George Freeman Stewart Mercer References 1 Howie J, Porter M. Stress and interventions for stress in general practitioners. In Firth-Cozens J, Payne R (eds). Stress in Health Professionals, Chichester: Wiley,1999:163-176. 2 Williams M, Neal RD. Br J Gen Pract 1998;48:1783-1786. 3 Maxwell M, Heaney DJ, Howie JGR etal. Acceptability of methods and measures used to determine quality of general practice consultations; results of a focus group study and an acceptability questionnaire. Primary Health Care Research and Development 2002;3:29-41. 4 RCGP Scotland: http://www.caremeasure.org.uk 5 Roland M. The Quality and Outcomes Framework. Br J Gen Pract 2007;525-527. Conflict of Interest:None declared |
|||