Despite spending 14.6 per cent of GDP on healthcare, the US performed poorly in a World Health Organisation report on international health system performance, the meeting was told.
Prof Larry Culpepper, chairman of the department of family medicine at Boston University, said one reason was that one person in six in the US was either under-insured or not insured for healthcare. There was also a significant specialist-to-primary care imbalance. Referring to a recent US Institute of Medicine report, Crossing the Quality Chasm, he out lined the challenges faced by primary care. These included the need to change to medical care based on continuous healing relationships. Professional autonomy must give way to a system based on patients' needs and values, he said.
Medical decision-making must take place using an evidence base rather than just training and experience, while a system which anticipated patient need was required. Prof Culpepper described efforts of his practice to create a culture of customer service. Reaching the practice by phone was one problem; 12 per cent of patients abandoned calls because of significant delays in being answered. This dropped to 3 per cent following remedial action. Patient satisfaction also increased when appointments were guaranteed within two days rather than weeks.
Dr Michael Boland, director of the postgraduate resource centre at the Irish College of General Practitioners, said trust was a big issue. "The public are questioning our motives," he said, referring to self-protection, a closed medical establishment and money.
Dr Karena Hanley, a Donegal GP, outlined how a group of doctors from the Republic and Northern Ireland changed their performance through auditing the care of patients with depression.
They identified key markers of quality practice such as whether the risk of suicide had been assessed and whether patients were on the correct therapeutic dosage of anti-depressant medication. Each practice set about improving its performance and when a second audit was carried out a year later, significant improvements in the quality markers had taken place.