1. Estonian Society of Family Doctors
Accreditation System in Family Medicine – Estonian experience.
Le Vallikivi
July 2017

2. Estonian situation today
1,3 milj inhabitants
Gate-keeper frontline system staffed by GP-s
Mixed payment system – 79,9% per capita, 18,2% fee for service, 1,2% P4P (by EHIF)
458 GP-led private clinics (359 mono), 805 GP-s

3. History of quality management
From 2006 P4P by EHIF for quality of care, consisting prevention, management of chronic diseases – DM2, AH, HT, MI, special skills and recertification of GP-s and nurses

4. From 2009
Quality Standards for Primary Care Practice – initialized, developed and published by Estonian Society of Family Doctors

5. Why? ...to analyze ... to compare practices
... to show that we do well
...to make the development of practices more systemic
...to standardize
...to raise medium quality level

6. The Standard consists I - Access to practice
II – Organization of practice work
III – Quality of medical treatment
IV – Practice as a base for studying and science

7. written text-document which describes standards
The Standard consists
written text-document which describes standards
table of indicators
questionaire for patients feedback
digital table for practices data (in digital educational environment – intranet - Svoog)

8. Audit of practice quality
2009/2010 on voluntary basis, auditors from ESFD: 79 practices taking part 18 practices reaching level A after auditing 2015/16 on voluntary bases, but auditors also from EHIF and National Health Board involved: 265 practices taking part 54 practices reaching level A after auditing 2016/17 on mandatory basis and A and B level funded by EHIF: 314 practices of 458 taking part 102 practices audited (evaluation in process) Standards beeing upgraded (in process)

9. Pros and cons Is it possible to standardize quality in PC?
Competition between collegues
Audit from collegues
Public attention
Additional money for practice(P4P)

10. Still
Quality of family medicine is not only a quality of therapy. Organization matters a lot.
Thank You