Table 1 Characteristics of different stakeholders’ A&F
Stakeholder and role | Regional managers (Purchasers and funding agents) | Owners of the HCs (public or private) | The regional pharmaceutical committees and Strama groups | The primary care R&D unit |
|---|---|---|---|---|
Aim | Control compliance to contractual obligations | Monitor revenues, expenditures and general performance | Monitor prescriptions at the HCs and stimulate QI | Facilitate learning and innovation through local improvement activities |
Frequency | Annually | Often monthly | Annually | Annually |
Form | Often face–to–face, sometimes by video link, sometimes sending out data reports only | Sometimes face– to–face meetings, but usually sending out data reports only | Often face–to–face meetings or video meetings, but sometimes sending out data reports only | Audit reports in combination with face–to–face meetings |
Participants from HC | Usually limited to HC managers and key staff selected by the HC manager | HC managers (who distribute information to the staff) | HC managers and key staff at the HCs | HC managers and key staff at the HCs |
Measures and targets | Facilities, staffing, opening hours and collaboration agreements with a focus on non–clinical measures Quality of care measures often linked to financial P4P incentives | Expenditures, utilisation of services (e.g. diagnostic procedures) and other non–clinical measures. Process measures linked to financial incentives (e.g. number of visits and waiting times) | Mainly clinical measures linked to treatment guidelines, evidence–based national targets and regional recommendations on drug use, including restrictive use of antibiotics | A combination of mainly clinical measures compiled by the R&D unit, reflecting quality of care for different patient groups. Discussion and reflection rather than goals |
Descriptive quotes from focus group participants | We have contractual follow–up by the reginal purchasers. They sent us feedback and asked us to comment on it. It can be clinical data, but it can also be about accessibility or staffing. Anything is possible. It can be for example [treatment with] anticoagulants. [And then they ask us to] tell them what we think about our results. Last time it was about patient safety. (HC B, manager) | Some feedback about finances, how we are doing on prescriptions, diagnostic procedures and laboratory tests. Then we also get feedback on how we are doing on medication reviews of patients taking more than 10 drugs, how many we have done, and the cost of drugs for diabetes, asthma, and COPD and what else is it …? (HC A, manager) | There has been a lot of feedback on [how we prescribe] antibiotics. Strama have been very much out visiting … to check that we follow the guidelines (HC C, Medical officer) | We have had a follow–up every year from the R&D unit and it has been valuable (VC E, manager) We do not have the energy or tools to set aside time ourselves to find out how many patients have heart failure or atrial fibrillation and [how many of them have] this treatment in that dose… (HC G, manager) |