Perceived effectiveness of diagnostic and therapeutic guidelines in primary care quality circles.

OBJECTIVE The main objectives of this study were to implement quality circle programs among general practitioners and to evaluate this quality management tool as a way to develop clinical guidelines in general practice. DESIGN The quality circle program was evaluated within a formative and summative evaluation design by both participants and moderators for a period of 18 months using structured questionnaires. At time one, participants were asked about their goals and current job satisfaction, and rated the perceived effectiveness and the usefulness of predefined guidelines of each quality circle meeting. At time two, participants and moderators reported again about their achieved goals and job satisfaction. SETTING AND STUDY PARTICIPANTS Two hundred and forty-three general practitioners in a district of South Germany (Südbaden), in 25 quality circle groups participated. MAIN MEASURES Demographic variables of the participating physicians, quality circle goals, job satisfaction, usefulness of guidelines and perceived effectiveness of the quality circle process were collected. RESULTS One hundred and six quality circle meetings were evaluated. When asked to rank the goals of quality circle work, participants provided the highest rankings for improvement of the doctor-doctor relationship, agreeing on consensus for diagnostic procedures and therapy management, and developing local guidelines. The comparison between time one and time two ratings provided evidence for an increase in overall job satisfaction. Higher benefit is correlated with more regular participation in quality circle meetings. CONCLUSION Working with predefined guidelines is both feasible and effective in quality circles and may provide a starting point for developing guidelines in primary care. There is some empirical evidence that participating in quality circles may increase general practitioners' job satisfaction. Further studies using intervention and control group designs should investigate whether quality circles really improve daily practice through clinical audit and benchmarking techniques.