Inspectorate Gives Summary Of Study Done Of General Practioners Care On St.Maarten

The following is the document from the Inspectorate regarding a study that was done regarding General Practioner care here on the island.


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1. Summary

The conditions for qualitatively responsible GP care have not been met yet, there is still much room for improvement.
The 20 GPs practicing in St. Maarten all except for one completed a questionnaire (Appendix 1) and all (except one who refused to cooperate) were visited by the inspectorate at their clinics.
The most important part of the survey was to examine whether the GP’s complied with the conditions for qualitatively responsible care, given the fact that no substantive guidelines on the medical content exist on Sint Maarten.
Most GPs perform their job very enthusiastic and care a lot for their patients.

The establishment of the clinics were almost always in order, neat and tidy. The accessibility to the clinics for disabled patients however, was not always assured.

Attention should also be paid to the various medical devices used in the clinic. Technical maintenance was very poor .
In St. Maarten GPs are organized into 2 organizations, the WIMA and the SMA. These provide an opportunity for peer to peer contacts, to learn from each other and to organize common and continuous training.
Yet it is striking that in St. Maarten professional communication about the individual patient and the organization of care is a major problem. And not just between the GP’s and the medical specialists but also between GPs and pharmacists. Of course both parties have responsibilities in improving this issue.
Except for interprofessional contacts within the WIMA and SMA the peer to peer contacts within the GP group needs improvement.

In particular, the quality of patient files are often very poor.

This differs considerably from the GP’s using an electronic patient record (EPR). They produce a legible decursus always with a good overview of diagnosis (s), policy and course.
The inspection is very surprised by the agreement between GPs in St. Maarten and the SMMC concerning GP care during the night and weekends which is provided at the emergency room of the SMMC . This means that almost none of the general practitioners are available at night or in weekends. This also means that the emergency room of the SMMC does figurative work and most of the time has a long waiting line. This affects the quality of care provided negatively.
Most GPs can be consulted by telephone during office hours, however home visits to less ambulant patients and emergency visits are not provided by a lot of GP’s . This is an explanation for the fact that many GPs do not possess a doctors bag any more.
St. Maarten has no accreditation for GPs. Vocational training is not mandatory.

During the interviews it was often unclear how GPs maintained their skills.

The inspectorate recommends the following key improvements:

1) Develop a registration system for general practitioners and establish requirements concerning necessary training and GP skills
-To be addressed to: VSA-Minister, physician organizations, GP, insurance companies

2) Cancel the arrangement between GPs and SMMC to see patients in the emergency department during ANW hours. Create a GP post at the SMMC managed and operated by GPs.
-To be addressed to: VSA-Minister, physician organizations, SMMC, health insurer

3) A sound professional communication between GPs , pharmacists and medical specialists is a conditio sine qua non. In St. Maarten non-communication between professionals is unacceptable.
-To be addressed to:-General Practitioners, physician organizations, pharmacists, medical specialists

4) Improve the quality of the patient files: anyone who has access to the file must quickly see what the diagnosis (s) is (are), which treatment policy is in effect and with which result.
-To be addressed to:-General Practitioners

5) Improve the quality of care by developing evidence based diagnostic and treatment protocols/guidelines for common medical conditions

-To be addressed to General Practitioners, specialists, pharmacists, professional organizations.

6) Urgent introduction is necessary of an electronic health record (EHR). This helps to solve the majority of the items under section 4.
-To be addressed to:-General Practitioners, physician organizations, health insurer

7) Ensure that the practice is easily accessible for the disabled
-To be addressed to:-General Practitioners

8) Provide proper technical maintenance of equipment
-To be addressed to:-General Practitioners