Peer review in primary care.

In a district of the town of Nijmegen in the Netherlands, 322 family physicians were approached to take part in an intensive peer review programme: 73% agreed to take part. The problems doctors experienced at the start of the programme were: a dislike of being criticized and doubts about such an investment of time. As the programme got going most of the problems shrank in size whilst the problem of changing their practice routines to meet certain guidelines for quality of care imposed by the programme grew. Nevertheless, for the large majority participation was a very valuable experience. By means of a gradual and personal approach towards doctors, systematic procedures for assessment and feedback, variation in topics and methods, and good organization and guidance it is possible to make quality assurance by means of peer review into a valuable aspect of the daily work of many care providers.