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Fiol-deRoque MA, Valderas JM, Arias de la Torre J, Serrano-Ripoll MJ, Gens-Barberà M, Sánchez-Freire E, Martín-Luján FM, Olry de Labry A, Ricci-Cabello I. Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire. Eur J Gen Pract 2024; 30:2296573. [PMID: 38197321 PMCID: PMC10783822 DOI: 10.1080/13814788.2023.2296573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability. OBJECTIVES To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact. METHODS Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity. RESULTS 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories. CONCLUSION The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .
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Affiliation(s)
- Maria A. Fiol-deRoque
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - José M. Valderas
- Centre for Research in Health Systems Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- CIBER Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
- Institute of Biomedicine, University of Leon, Leon, Spain
| | - Maria J. Serrano-Ripoll
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Montserrat Gens-Barberà
- Quality and Patient Safety Central Functional Unit, Gerència d‘Atenció Primària Camp de Tarragona, Catalan Institute of Health (ICS), Tarragona, Spain
- Research Group in Quality and Patient Safety, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
| | - Encarna Sánchez-Freire
- Quality and Patient Safety Unit, Gerència d‘Atenció Primària Catalunya Central, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Francisco M. Martín-Luján
- Primary Healthcare Research Support Unit-Camp de Tarragona, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Antonio Olry de Labry
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Group in Health and Gender, Andalusian School of Public Health, Granada, Spain
| | - Ignacio Ricci-Cabello
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Serrano-Ripoll MJ, Fiol-deRoque MA, Valderas JM, Zamanillo-Campos R, Llobera J, de Labry Lima AO, Pastor-Moreno G, Ricci-Cabello I. Feasibility of the SINERGIAPS ("Sinergias entre profesionales y pacientes para una Atención Primaria Segura") intervention for improving patient safety in primary care. Fam Pract 2022; 39:843-851. [PMID: 35253839 DOI: 10.1093/fampra/cmac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The primary aim was to examine the feasibility of intervention delivery and of trial procedures. Secondary aims were to study the intervention uptake; its acceptability and perceived utility; and its potential to improve safety culture and avoidable hospital admissions. METHODS We conducted a 3-month, single-arm feasibility study in 10 primary care (PC) centres in Spain. Centres received information regarding patients' experiences of safety (through the Patient Reported Experiences and Outcomes of Safety in Primary Care [PREOS-PC] questionnaire), and were instructed to plan safety improvements based on that feedback. We used a bespoke online tool to recruit PC professionals, collect patient feedback, and deliver it to the centres, and to collect outcome data (patient safety culture [Medical Office Survey on Patient Safety Culture, MOSPSC questionnaire]). We measured recruitment and follow-up rates and intervention uptake (based on the number of safety improvement plans registered). We conducted semistructured interviews with 9 professionals to explore the intervention acceptability and perceived utility. RESULTS Of 256 professionals invited, 120 (47%) agreed to participate, and 97 completed baseline and postintervention measures. Of 780 patients invited, 585 (75%) completed the PREOS-PC questionnaire. Five of 10 centres (50%) designed an improvement plan, providing 27 plans in total (range per centre, 1-14). The intervention was perceived as a novel strategy for improving safety, although the healthcare professionals identified several factors limiting its acceptability and utility: lack of feedback at the individual professional level; potentially unrepresentative sample of patients providing feedback; and number of educational materials deemed overwhelming. DISCUSSION It is feasible to deliver the proposed intervention so long as the identified limitations are addressed.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,University of the Balearic Islands, Psychology Department, Palma, Illes Balears, Spain
| | - Maria A Fiol-deRoque
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - José M Valderas
- Yong Loo Lin School of Medicine, National University of Singapore and Department of Family Medicine, National University Health System, Singapore
| | - Rocío Zamanillo-Campos
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Primary Care Preventive and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Antonio Olry de Labry Lima
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain.,Research Group in Health and Gender, Andalusian School of Public Health, Granada, Andalucía, Spain
| | - Guadalupe Pastor-Moreno
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain.,Research Group in Health and Gender, Andalusian School of Public Health, Granada, Andalucía, Spain
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
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Ricci-Cabello I, Yañez-Juan AM, Fiol-deRoque MA, Leiva A, Llobera Canaves J, Parmentier FBR, Valderas JM. Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data. J Clin Med 2021; 10:1782. [PMID: 33923906 PMCID: PMC8073542 DOI: 10.3390/jcm10081782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Aina María Yañez-Juan
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Nursing and Physiotherapy and Global Health Research Group, University of the Balearic Islands, 07122 Palma, Spain
| | - Maria A. Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
| | - Alfonso Leiva
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Joan Llobera Canaves
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Fabrice B. R. Parmentier
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Psychology and Institute of Health Sciences (iUNICS), University of the Balearic Islands, 07122 Palma, Spain
- School of Psychology, The University of Western Australia, Perth, WA 6009, Australia
| | - Jose M. Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR School for Primary Care Research, University of Exeter, Exeter EX1 2HZ, UK
- NIHR South West Peninsula Applied Research Collaboration, University of Exeter, Exeter EX1 2HZ, UK
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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