OECD’s PaRIS will shed light on family doctors’ contribution to PC

OECD’s PaRIS initiative will shed light on family doctors’ valuable contribution to improving primary care

by Candan Kendir, Jose M Valderas

PaRIS is the Organization for Economic Cooperation and Development (OECD)’s Patient-Reported Indicator Surveys initiative where countries work together on developing, standardising and implementing a new generation of indicators that measure the outcomes and experiences of health care.  The PaRIS survey assists countries in improving care for people living with chronic conditions by measuring outcomes and experiences with the primary and ambulatory care services that they use. Family doctors are the cornerstone of chronic care and the PaRIS survey will shed light on family doctors’ contribution to improving quality of care for people living with chronic conditions. Currently, 20 countries (Australia, Belgium, Canada, Czech Republic, France, Greece, Iceland, Israel, Italy, Luxembourg, Netherlands, Norway, Portugal, Romania, Saudi Arabia, Slovenia, Spain, Switzerland, United Kingdom, and United States) are participating in the first round of the PaRIS survey.  

PaRIS questionnaires and implementation plans are piloted in a Field Trial

The PaRIS survey of People Living with Chronic Conditions is the first ever large-scale international survey on the outcomes and experiences of people with chronic conditions and their primary care providers. A conceptual framework has been developed through a systematic, replicable and inclusive process, including the following domains: patient reported outcomes; patient reported experiences of care; health and health care capabilities; health behaviours; individual and sociodemographic factors; delivery system design; and health system design, policy and context. Based on the framework, a comprehensive patient questionnaire has been constructed by using existing validated measurement tools consisting of the following sections: Your health (PROMIS Global-10, WHO-5, and others), Managing your health and health care (Porter-Novelli and others), Your experience of health care (P3CEQ and others), About yourself (demographic variables). In addition, a provider questionnaire was developed collecting information on service delivery. The questionnaires were cognitively tested before being piloted in a Field Trial. The PaRIS conceptual framework and questionnaire developments will be presented in the WONCA Europe 2022 Conference in London. 

Most countries sample providers first, and then patients through participating providers. Few countries sample providers and patients separately due to existing data systems in place or administrative issues with retrieving patient contacts. Countries developed written plans, so called Country Road Maps, detailing implementation of the PaRIS survey in their respective countries to address country-specific characteristics while ensuring international comparability.
Participating countries are now piloting PaRIS questionnaires as well as their implementation plans. This enables improving the questionnaires, ensuring adequate performance and offering insights into how the questionnaires could be modified to reduce the burden of administration while balancing comprehensiveness and metric performance. The main Survey will begin in the end of 2022.

WONCA has been involved throughout the PaRIS survey in various roles

Successfully building a survey on this scale is a joined effort and requires the support of policy makers, patients, care providers and academics from across the globe. WONCA has been involved in the design of the PaRIS survey as part of the initial reflection committee, namely Task Force, with contributions of WONCA leadership and membership, including Amanda Howe, Job Metsemakers and Jose M Valderas and in the development and implementation as advisor to the decision-making committee, namely the Working Party for PaRIS, with contributions of Anna Stavdal. In addition, many family doctors from WONCA have taken roles in the PaRIS survey as:

• National Project Managers (Zalika Klemenc-Ketis from Slovenia and Bohumil Seifert from Czech Republic)- responsible for the implementation of the PaRIS survey in their respective countries, 
• Consortium partners (Jose M Valderas, University of Exeter and National University of Singapore , Chair of WONCA Working Party on Quality and Safety)- one of the Consortium leads is assisting the OECD methodologically in the development of patient and provider questionnaires and implementation of the PaRIS survey, including development and implementation of the analytical strategy, 
• Experts in the Technical Advisory Committee (Mehmet Akman, Chair of WONCA Working Party on Research; Michael Kidd, Past WONCA President; Toni Dedeu, WHO European Center for Primary Health Care)- providing methodological advice on international level, and 
• Team members in the International Project Management team (Candan Kendir, OECD)- developing and managing the PaRIS survey on international level.

Other family doctors have contributed in addition to the ones named here and many more are anticipate to contribute in the near future.

Individual family doctors will benefit from participating in the PaRIS survey

The support of family doctors can substantially improve response rates among patients; in return, family doctors will receive feedback data on the outcomes and experiences in their populations.

Individual family doctors are involved in the PaRIS survey in various roles, as informants (by completing a provider questionnaire themselves), as partners of the local research team (amongst others, by selecting and recruiting eligible patients) and as stakeholders or end-users. International and national PaRIS teams have been working to limit additional workload, for example by  collecting responses on service delivery from other primary care providers in the same clinic or dedicating additional people to support family doctors in retrieving patient lists. The OECD and its partners are committed to the highest standards of international compliance with data protection laws, regulation, and rules. More information on data protection and privacy can be found here.

The results of the PaRIS survey will be fed back to family doctors and their practice team, where relevant, therefore, they can see how outcomes and experiences of their population compares to those of regional, national, and international peers. No benchmarking across practices will be reported publicly as the PaRIS survey has not been developed for this purpose. Interested family doctors could identify their national contact person here and retrieve more information regarding the PaRIS survey in their respective countries. 

Extending the collaboration via the WONCA Working Party in Quality and Safety 

The WONCA Working Party on Quality and Safety is planning to build upon this successful and mutually benefitting collaboration as part of the WP´s strategic plan for coming years. The appointment of Candan Kendir as WP’s Executive as liaison with the OECD will facilitate further development of the collaboration with OECD in quality and safety in Primary Care in coordination with WONCA leadership.