The core of APO at local levels is the quality cycle. APO is a bottom-up approach developed on the terms of GPs – and not on the terms of the “system”. GPs participate on a voluntary basis driven by motivation. APO registration of RTIs has taken place for some years in the Nordic countries.
Guidelines for GPs have been issued based on the results from audit projects.
The APO method includes the following components:
− Initial registration of GPs own activities (3 weeks)
− Intervention including follow-up and course activities for GPs and media campaigns for patients (12 months)
− Final registration and evaluation (3 weeks)
The course activities include introduction of diagnostic tests. Intervention programmes for registration and quality development have been applied in the Nordic countries, and studies have shown that interventions using the APO method may serve as useful tools for inducing desirable changes in antibiotic prescribing
Potential impact of implementing the APO method for GPs
− Based on experience from the Nordic countries it can be expected that health care professionals by participating in APO will obtain a greater insight into their professional work and adopt a more critical attitude to their own performance.
− APO is expected to generate permanent effects on the quality of GPs. A controlled study focusing on quality improvement of antibiotic prescription in Denmark indicates that the positive effect of participating in APO may last for several years.
− APO is based on theories on learning and motivation. Breaking down barriers to behaviour change is a necessary prerequisite for improving clinical performance and APO cycles are therefore adapted to the participating GPs’ needs and the specific problems concerned.
− The participation in APO is voluntary. The GPs will develop a sense of ownership in the individual APO projects. An important factor is to give the individual GPs comparative data above their own practice, which is an important prerequisite for motivation to change practice. Participating GPs will tend to be well prepared and motivated during the follow-up meetings because they are forced to think systematically about the topic after the registration, partly because they have to explain and justify their own results, and finally because they have contributed to the total result.
− Based on earlier studies and theoretical considerations, APO seems to be an effective and simple method for quality improvement for GPs and the HAPPY AUDIT project will lead to a reduction in the inappropriate use of antibiotics, not only among the participating GPs but also in non-participating GPs.