Programme no. 364-P
Developing systematic electronic health records for preventive child health examinations in general practice through the use of an adapted nominal group technique
Elisabeth Søndergaard*1, Ruth Kirk Ertmann2, Susanne Reventlow3, Kirsten Lykke Nielsen4
1The Research Unit for General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 2The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 3The Research Unit for General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 4The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark
* = Presenting author
Objectives: To explore if the Nominal Group Technique (NGT) can be used to establish consensus in a complex field influenced by professionals’ know-how and ‘gut-feeling’ as well as national guidelines.
Background: In Denmark, the preventive healthcare program includes seven child health examinations from age 0-5 years carried out in general practice. The Danish National Board of Health provides general practitioners (GPs) with comprehensive guidelines. However, there is not a structured and systematic practice for which of the recommendations the child consultations, as a minimum, ought to entail. That makes it difficult for GPs to assure that they have in fact examined the child for the most important health conditions. The development of a systematic health record seems advantageous.
Results: Using the NGT as a working tool among an expert panel consisting of skilled practitioners proved to be an advantageous approach. The project resulted in applicable, practice-near suggestions for systematic electronic health records to be used during child examinations. Our findings identified the following main benefits: 1) keeping focus and facilitating equal speaking time; 2) serial meetings provided time for continued reflections on results and check-ups; 3) transfer of previously collected data; 4) produces a concrete take home product; 5) flexibility of the NGT model; discussions and thematic classification in pairs.
Material/Methods: A selected expert panel of six experienced general practitioners used the NGT – a structured, multistep facilitated group meeting technique – to generated consensus around key themes to include in systematic electronic health records for the first three out of seven preventive child health examinations. Besides the work carried out during the meetings two of the participating GPs continuously worked with the structure and format of the health records in the time between each meeting. The material consists of recommendations from the National Board of Health, documents from the three meetings, and field notes made during the last meeting.
Conclusion: The process of front-line health care professionals' using the nominal group technique to establish systematic structures to improve the quality of clinical practice is recommendable.
Points for discussion:
- Known experiences with developing consensus about systematic approaches to complex interventions?
- Which other areas within general practice could benefit from applying NGT as a working tool to reach consensus?
- What could be suggestions for better ways of developing the content for the electronic health records?