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Jeffs L, Kuluski K, Flintoft V, MacLaurin A, Asselbergs M, Zeng RL, Bruno F, Schonewille N, Baker GR. Reconceptualizing Patient Safety Beyond Harm: Insights From a Mixed-Methods Qualitative Inquiry. J Nurs Care Qual 2024; 39:226-231. [PMID: 38198670 DOI: 10.1097/ncq.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm. PURPOSE The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety. METHODS We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets. RESULTS Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety. CONCLUSION Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.
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Affiliation(s)
- Lianne Jeffs
- Author Affiliations: Science of Care Institute, and Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada (Dr Jeffs); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (Drs Jeffs, Kuluski, and Baker and Ms Flintoft); Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada (Dr Kuluski); Healthcare Excellence Canada, Ottawa, Ontario, Canada (Ms MacLaurin); Patients for Patient Safety Canada, Healthcare Excellence Canada, Ottawa, Ontario, Canada (Ms Asselbergs); and Sinai Health, Toronto, Ontario, Canada (Mss Zeng and Bruno and Mr Schonewille)
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Thomas R, Berry A, Cramp F, Walsh N. Patient perspectives of general practice consultation for musculoskeletal disorders: A qualitative study. Musculoskeletal Care 2024; 22:e1904. [PMID: 38837521 DOI: 10.1002/msc.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Musculoskeletal disorders (MSKDs) are a significant reason for general practice consultations in the United Kingdom. Current models of care include consultation with a General Practitioner (GP) or a First Contact Physiotherapy Practitioner (FCPP). Evidence suggests that FCPP led care is safe, yet it is unknown whether patients share this belief. PURPOSE To explore patients' perspectives of general practice consultation for MSKDs, including views on safety, satisfaction and recommendations for future practice. METHODS A secondary data analysis utilising qualitative data from the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire completed by 426 general practice patients who consulted with a MSKD between December 2019 and October 2022. Responses to the question 'What changes, if any, would you suggest to your GP surgery to make sure that health care is provided safely?' were analysed using content analysis. RESULTS 606 responses across three timepoints were analysed. Two themes and six subthemes were identified; views on safety and satisfaction (inherent trust in the system, provision of face-to-face appointments, prompt access to care, person-centred care) and recommendations for future practice (appointment system: prompt access to face-to-face appointments, delivery of care: co-ordinated and collaborative person-centred care). CONCLUSIONS Patients commented that FCPP consultations provided quick and accurate diagnoses and targeted advice. Recommendations for future practice included prompt access to face-to-face appointments, phone calls to be answered more quickly, improved communication for test results and follow ups, patients to feel listened to with a more individualised approach, and better continuity of care.
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Affiliation(s)
- Rachel Thomas
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alice Berry
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Fiona Cramp
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Nicola Walsh
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Stray K, Wibe T, Debesay J, Bye A. Older adults' perceptions and experiences of interprofessional communication as part of the delivery of integrated care in the primary healthcare sector: a meta-ethnography of qualitative studies. BMC Geriatr 2024; 24:146. [PMID: 38347442 PMCID: PMC10863142 DOI: 10.1186/s12877-024-04745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Communication between patients and healthcare providers, and effective interprofessional communication, are essential to the provision of high-quality care. Implementing a patient-centred approach may lead to patients experiencing a sense of comfort, validation, and active participation in own healthcare. However, home-dwelling older adults' perspectives on interprofessional communication (IPC) are lacking. The aim is therefore to explore how home-dwelling older adults experience communication in connection with the delivery of integrated care. METHODS The meta-synthesis was conducted in line with Noblit and Hare's seven phases of meta-ethnography. A systematic literature search was conducted by two university librarians in seven databases using the search terms 'older adults', 'communication', 'integrated care' and 'primary care'. All articles were reviewed by two authors independently. 11 studies were included for analysis. RESULTS Older adults are aware of IPC and have preferences regarding how it is conducted. Three main themes were identified in the reciprocal analysis: (1) Inconsistent care perceived as lack of IPC, (2) individual preferences regarding involvement and awareness of IPC and (3) lack of IPC may trigger negative feelings. CONCLUSIONS This meta-ethnography shows the perspective of older adults on IPC as part of integrated care. Our study shows that older adults are concerned about whether healthcare personnel talk to each other or not and recognise IPC as fundamental in providing consistent care. The perspectives of older adults are relevant for clinicians and politicians, as well as researchers, when developing and implementing future integrated care services for home-dwelling older adults.
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Affiliation(s)
- Karoline Stray
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services, City of Oslo, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Tyler N, Planner C, Shears B, Hernan A, Panagioti M, Giles S. Developing the Resident Measure of Safety in Care Homes (RMOS): A Delphi and Think Aloud Study. Health Expect 2023; 26:1149-1158. [PMID: 36797827 PMCID: PMC10154851 DOI: 10.1111/hex.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. INTRODUCTION Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. METHODS We developed 73 evidence-based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. RESULTS The 29-item RMOS was developed. Forty-three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. CONCLUSION We have a developed an evidence-based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia-friendly version to promote inclusivity. PATIENT OR PUBLIC INVOLVEMENT Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Bethany Shears
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Andrea Hernan
- Faculty of Health, Deakin University, Warrnambool, Australia
| | - Maria Panagioti
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Sally Giles
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Kim MS, Cho YO, Park J. Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study. NURSING REPORTS 2022; 12:861-872. [PMID: 36412802 PMCID: PMC9680421 DOI: 10.3390/nursrep12040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan 48513, Republic of Korea
| | - Young Ok Cho
- Hyosung City Hospital, Busan 48055, Republic of Korea
| | - Jiwon Park
- Department of Nursing, Pukyong National University, Busan 48513, Republic of Korea
- Correspondence:
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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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Mounce LTA, Salema NE, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Kadam UT, Valderas JM. Development of 2 Short Patient-Report Questionnaires of Patient Safety in Primary Care. J Patient Saf 2022; 18:161-170. [PMID: 35344976 DOI: 10.1097/pts.0000000000000880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) is a valid and reliable instrument (61 items across 5 domains) of patients' perceptions of safety. Stakeholder feedback has supported shorter versions for improving choice and facilitating uptake of routine patient-centered evaluation. We sought to develop 2 shorter versions of PREOS-PC: one including the shortest possible scales that met established measurement performance standards and a screening version including a single item per domain. METHODS A total of 1244 patients from 45 general practices across England completed PREOS-PC questionnaires. All scale items in PREOS-PC underwent Item Response Theory analysis, applying standard criteria for the item reduction. Cognitive debriefing from 10 patient interviews allowed for the assessment of the instruments' readability. The instruments' psychometrics properties were reassessed in a validation sample of 1557 patients in 21 English general practices. RESULTS "PREOS-PC Compact" includes 25 items and 2 open-ended questions across the 5 domains, 44% of the length of the original instrument. "PREOS-PC Screen" consists of 6 items: the best-performing single items for 2 domains, 1 item modified from original items for each of the remaining 3 domains, and 1 open-ended question. The evaluation of the instruments confirmed they were acceptable to patients and met standards for readability; construct, convergent, and divergent validity; and reliability. CONCLUSIONS PREOS-PC Compact meets high-performance standards while reducing patient burden for routine monitoring of patient safety in primary care. PREOS-PC Screen is a concise tool apt for incorporation into audits and to target more in-depth review as needed.
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Affiliation(s)
- Luke T A Mounce
- From the Health Services and Policy Research Group, University of Exeter Medical School, Exeter
| | - Nde-Eshimuni Salema
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | | | - Anthony J Avery
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Umesh T Kadam
- Department of Health Sciences, University of Leicester, England
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Serrano-Ripoll MJ, Llobera J, Valderas JM, de Labry Lima AO, Fiol-deRoque MA, Ripoll J, Ricci-Cabello I. Cross-Cultural Adaptation, Validation, and Piloting of the Patient Reported Experiences and Outcomes of Safety in Primary Care Questionnaire for Its Use in Spain. J Patient Saf 2022; 18:102-110. [PMID: 35188925 DOI: 10.1097/pts.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain. METHODS After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients' evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions. RESULTS Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales ("safety problems," "harm severity," "harm needs"). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months. CONCLUSIONS The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.
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Affiliation(s)
| | | | - José M Valderas
- Health Services and Policy Research Group, University of Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, United Kingdom
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Gens-Barberà M, Hernández-Vidal N, Castro-Muniain C, Hospital-Guardiola I, Oya-Girona EM, Bejarano-Romero F, Rey-Reñones C, Martín-Luján F. [Patient safety incidents reported before and after the start of the COVID-19 pandemic in Primary Care in Tarragona]. Aten Primaria 2021; 53 Suppl 1:102217. [PMID: 34961580 PMCID: PMC8708815 DOI: 10.1016/j.aprim.2021.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objetivo Analizar y comparar la epidemiologia de los incidentes de seguridad del paciente notificados en centros de atención primaria, antes y después del inicio de la pandemia COVID-19. Diseño y emplazamiento Estudio descriptivo analítico comparando los incidentes notificados del 01-marzo-2019 al 28-febrero-2020, y del 01-marzo-2020 al 28-febrero-2021, realizados a través de la plataforma TPSC Cloud™ accesible desde la Intranet corporativa en 25 centros de atención primaria del distrito de Tarragona, Cataluña, España. Mediciones Registros obtenidos a partir de notificaciones voluntarias mediante formulario electrónico, estandarizado y anonimizado. Variables: centro sanitario, profesional, tipo de incidente, matriz de riesgo, factores causales, contribuyentes y evitabilidad. Análisis estadístico: Se realizó análisis descriptivo del total de notificaciones y otro específico de los eventos adversos, comparando ambos períodos. Resultados Se notificaron un total de 2.231 incidentes. Comparando ambos períodos, en el de pandemia se observó una reducción del número de incidentes notificados (solo representaron un 20% del total), pero en proporción se incrementó el porcentaje de notificaciones por parte de profesionales sanitarios y el de eventos adversos que requirieron observación. También aumentaron los factores causales relacionados con los cuidados y el diagnóstico, y disminuyeron los de medicación. Además, se observó un incremento de los factores contribuyentes relacionados con el profesional. La evitabilidad fue elevada (>95%) en ambos períodos. Conclusiones Durante la pandemia, se han notificado un menor número de incidentes de seguridad del paciente, pero en proporción, más eventos adversos, siendo en su mayoría evitables. El propio profesional se convierte en el principal factor contribuyente.
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Affiliation(s)
- Montserrat Gens-Barberà
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España.
| | - Núria Hernández-Vidal
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Carles Castro-Muniain
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Inmaculada Hospital-Guardiola
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centro de Atención Primaria Dr. Turró, Valls, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Eva Maria Oya-Girona
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centre d'Alta Resolució, Salou, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Ferran Bejarano-Romero
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Cristina Rey-Reñones
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
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Fiol-deRoque MA, Serrano-Ripol MJ, Gens-Barberà M, Sánchez E, Mayer MA, Martín-Luján F, Valderas JM, Ricci-Cabello I. [Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]. Aten Primaria 2021; 53 Suppl 1:102222. [PMID: 34961582 PMCID: PMC8708814 DOI: 10.1016/j.aprim.2021.102222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the impact of the changes introduced in response to the pandemic on patient-reported patient safety in Primary Care. DESIGN Prospective observational panel study (health center) based on two cross-sectional surveys. SETTING 29 Primary Health Care centers from three Spanish health regions (Mallorca, Catalunya Central and Camp de Tarragona). PARTICIPANTS Random sample of patients visiting their centers before (n=2199 patients) and during the pandemic (n=1955 patients) MAIN MEASUREMENTS: We used the PREOS-PC questionnaire, a validated instrument which assesses patient-reported patient safety in Primary Care. We compared mean scores of the "experiences of errors" and "harm" scales in both periods, and built multilevel regression analyzes to study the variations in patient and center characteristics associated with worse levels of safety. A qualitative (content) analysis of patients' experiences during the pandemic was also performed. RESULTS The "experiences of errors" and "harm" scales scores significantly worsened during the COVID-19 period (92.65 to 88.81 (Cohen's d=0.27); and 96.92 to 79.97 (d=0.70), respectively). Patient and center characteristics associated to worsened scores were: women, people with a lower educational level, worse health status, more years assigned to the center, and health region. CONCLUSIONS During the pandemic, a perceptible worsening in patient safety perceived by patients treated in Primary Care has been observed, which has differentially affected patients according to their sociodemographic characteristics or health center profiles.
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Affiliation(s)
- Maria A Fiol-deRoque
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España
| | - Maria J Serrano-Ripol
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Universidad de las Islas Baleares (UIB), Departamento de Psicología, Palma, Islas Baleares, España.
| | - Montserrat Gens-Barberà
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Encarna Sánchez
- Unitat de Qualitat i Seguretat, Gerència Territorial Catalunya Central, Institut Català de la Salut, Departament de Salut, Barcelona, España
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics (GRIB) del Instituto Hospital del Mar de Investigaciones Médicas y la Universitat Pompeu Fabra, Barcelona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, España
| | - José M Valderas
- Health Services & Polic Research Group, Exeter Collaboration for Academic Primary Care, University of Exeter, National Institute for Health Research School for Primary Care Research
| | - Ignacio Ricci-Cabello
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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11
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Thilsted SL, Folke F, Tolstrup JS, Thygesen LC, Gamst-Jensen H. Possible associations between callers' degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study. BMC Emerg Med 2021; 21:53. [PMID: 33910517 PMCID: PMC8080378 DOI: 10.1186/s12873-021-00452-0] [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: 08/08/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background Telephone triage within out-of-hours (OOH) services aims to ascertain the urgency of a caller’s medical condition in order to determine the correct type of health care needed, ensuring patient safety. To improve the triage process by increasing patient-centred communication, a triage tool has been developed, whereby callers are asked to rate their degree-of-worry (DOW) as a measure of self-evaluated urgency. Studies show that low socioeconomic status (SES), being single and non-Western ethnicity are associated to low self-rated health and high morbidity and these factors may also be associated with high DOW. The aim of this paper was to examine if low SES, being single and non-Western ethnicity were associated to high DOW of callers contacting OOH services. Methods A prospective cohort study design, at the OOH services for the Capital Region of Denmark. Over 2 weeks, 6869 of 38,787 callers met the inclusion criteria: ≥18 years, patients themselves or close relative/friend, reported DOW, had a valid personal identification number and gave informed consent. Callers were asked to report their DOW (1 = minimal worry to 5 = maximal worry), which was dichotomized into low (1–3) and high (4, 5) DOW and linked to data from electronical medical records and Statistics Denmark. Socioeconomic factors (education and annual household income), marital status and ethnicity were assessed in relation to DOW by logistic regression. Results High DOW was reported by 38.2% of the participants. Low SES (low educational level; OR 1.5, 95% CI 1.3–1.7 and low annual household income; 1.5, 1.3–1.6) was associated with high DOW and so too was being single; 1.2, 1.1–1.3 and of non-Western ethnicity; 2.9, 2.5–3.4. Conclusions Knowledge of the association of low SES, marital status as single and non-Western ethnicity with high DOW among callers to OOH services may give call handlers a better understanding of callers’ DOW. If this does not correspond to the call handler’s perception of urgency, this knowledge may further encourage patient-centred communication, aid the triage process and increase patient safety. A better understanding of socioeconomic variables and their relation to callers’ DOW gives direction for future research to improve telephone triage of OOH services.
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Affiliation(s)
- Sita LeBlanc Thilsted
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hejdi Gamst-Jensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark.,Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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12
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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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Khan AH, Abbe A, Falissard B, Carita P, Bachert C, Mullol J, Reaney M, Chao J, Mannent LP, Amin N, Mahajan P, Pirozzi G, Eckert L. Data Mining of Free-Text Responses: An Innovative Approach to Analyzing Patient Perspectives on Treatment for Chronic Rhinosinusitis with Nasal Polyps in a Phase IIa Proof-of-Concept Study for Dupilumab. Patient Prefer Adherence 2021; 15:2577-2586. [PMID: 34848949 PMCID: PMC8611726 DOI: 10.2147/ppa.s320242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient perspective is an important and increasingly sought-after complement to clinical assessment. The aim of this study was to transcribe individual patients' experience of treatment in a dupilumab clinical trial through free-text responses with analysis using natural language processing (NLP) to obtain the unique perspective of patients on disease impact and unmet needs with existing treatment to inform future trial design. PATIENTS AND METHODS Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who were enrolled in a Phase IIa randomized controlled trial comparing dupilumab with placebo (NCT01920893) were invited to complete a self-assessment of treatment (SAT) tool at the end of treatment, asking, "What is your opinion on the treatment you had during the trial? What did you like or dislike about the treatment?" Free-text responses were analyzed for the overall cohort and according to treatment assignment using natural language processing including sentiment scoring. In a mixed-methods approach, quantitative patient-reported outcome (PRO) results were utilized to complement the qualitative analysis of free-text responses. RESULTS Of 60 patients enrolled in the study, 43 (71.6%) completed the SAT and responses from 37 patients were analyzed (placebo, n = 16; dupilumab, n = 21). Word analyses showed that the most common words were "smell," "improve," "staff," "great," "time," and "good." Across the whole cohort, "smell" was the most common symptom-related word. The words "smell" and "experience" were more likely to occur in patients treated with dupilumab. Patients treated with dupilumab also had more positive sentiment in their SAT responses than those who received placebo. The results from this qualitative analysis were reflected in quantitative PRO results. CONCLUSION "Smell" was important to patients with CRSwNP, highlighting its importance as a patient-centric efficacy outcome measure in the context of clinical trials in CRSwNP. TRIAL REGISTRATION ClinicalTrials.gov, NCT01920893. Registered 12 August 2013, https://www.clinicaltrials.gov/ct2/show/NCT01920893.
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Affiliation(s)
- Asif H Khan
- Sanofi, Chilly-Mazarin, France
- Correspondence: Asif H Khan Sanofi, 1 Avenue Pierre Brossolette, Chilly-Mazarin, 91380, FranceTel +33 1 60 49 77 77 Email
| | | | - Bruno Falissard
- Centre de recherche en epidémiologie et santé des populations (CESP), INSERM U1018, Paris, France
| | | | - Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona; Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; and CIBERES, Barcelona, Catalonia, Spain
| | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM. Identifying Factors Leading to Harm in English General Practices: A Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis. J Patient Saf 2021; 17:e20-e27. [PMID: 32175959 DOI: 10.1097/pts.0000000000000669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study was to identify the main factors leading to harm in primary care based on the experiences reported by patients. METHODS We conducted a mixed-methods, cross-sectional study in 45 primary care centers in England. A random sample of 6736 patients was invited to complete the Patient-Reported Experiences and Outcomes of Safety in Primary Care questionnaire. We fitted structural equation modeling on the quantitative data (n = 1244 respondents) to identify contributory factors and primary incidents leading to harm. We conducted content analyses of responses to seven open-ended questions (n = 386) to obtain deeper insight into patient perceptions of the causes of harm experienced. Results from quantitative and qualitative analyses were triangulated. RESULTS Patients reported harm related to physical health (13%), pain (11%), and mental health (19%) and harm that increased limitations in social activities (14%). Physical harm was associated with incidents affecting diagnosis (β = 0.43; delayed and wrong), and treatment (0.12; delayed, wrong treatment, or dose), which were in turn associated with incidents with patient-provider communication, coordination between providers, appointments, and laboratory tests. Pain was associated with laboratory tests (0.21; caused when collecting blood or tissue samples) and with problems booking an appointment when needed (0.13; delaying treatment for pain). Harm to mental health was associated with incidents related to the following: diagnosis (0.28), patient-provider communication (0.18), appointments (0.17), coordination between different providers (0.14), and laboratory tests (0.12). Harm increasing limitations in social activities was associated with incidents related to diagnosis (0.42) and diagnostic and monitoring procedures (0.20). CONCLUSIONS Our findings suggest the need for patient-centered strategies to reduce harm in primary care focusing on the improvement of the quality of diagnosis and patient-provider communication.
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Affiliation(s)
| | - Jaheeda Gangannagaripalli
- Health Services & Policy Research Group, Patient Centred Care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Luke T A Mounce
- Health Services & Policy Research Group, Patient Centred Care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Jose María Valderas
- Health Services & Policy Research Group, Patient Centred Care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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15
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Fernholm R, Wachtler C, Malm-Willadsen K, Holzmann MJ, Carlsson AC, Nilsson GH, Pukk Härenstam K. Validation and initial results of surveys exploring perspectives on risks and solutions for diagnostic and medication errors in primary care in Sweden. Scand J Prim Health Care 2020; 38:381-390. [PMID: 33307931 PMCID: PMC7782021 DOI: 10.1080/02813432.2020.1841531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To (1) validate and (2) display initial results of surveys to health care professionals and patients on the importance and mitigation of specified risks for diagnostic and medication errors. DESIGN For validation, psychometric properties were analysed by assessment of construct validity and internal consistency by factor analysis. Non-parametric analyses were used concerning areas of risk, and top ranking of solutions were reported descriptively. SETTING Primary health care in Sweden. PARTICIPANTS Health care professionals (HCPs); including physicians, nurses and practice managers, as well as patients who had experienced diagnostic or medication errors. MAIN OUTCOME MEASURES Psychometric properties of the surveys. Median ratings for risks and top rankings of solutions for professionals and patients. RESULTS There were 939 respondents to the HCP survey. Construct validity resulted in a model with four dimensions: Patient-provider level; Support systems for every day clinical work; Shared information and cooperation between different caregivers; Risks in the environment. Internal consistency was acceptable with Cronbach's α values above 0.7. Confirmatory factor analysis generally showed an acceptable fit. Initial results from the professionals showed the importance of continuity of care, a nationwide on-line medical platform and cooperation in transfer of care. The patient survey could not be validated because of low response rate. CONCLUSION The HCP survey showed some contradicting results regarding model fit and may be tentatively acceptable but validity needs further study. HCP survey answers indicated that relational continuity of care and a nationwide on-line medical platform are highly valued. Current awareness Health care professionals and patients are rather untapped sources of knowledge regarding patient safety in primary health care Main statements Validation is performed on a new survey capturing rating of risks and solutions. The validation of the health care professional survey is tentatively acceptable. Survey answers indicate that health care professionals' and patients' perspectives are complementary.
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Affiliation(s)
- Rita Fernholm
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Caroline Wachtler
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Karolina Malm-Willadsen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Martin J. Holzmann
- Department of Medicine, Stockholm, Sweden
- Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Gunnar H. Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Karin Pukk Härenstam
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden
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16
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McCloskey RM, Furlong KE, Hansen L. Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2020; 17:754-792. [PMID: 30889068 DOI: 10.11124/jbisrir-2017-003737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on patients', family members' and nurses' experiences with bedside handovers in acute care settings. INTRODUCTION The transfer of patient information between nurses represents a critical component of safety within health care. Conducting handover at the bedside allows patients and families to participate in information exchanges. Studies that address bedside handover highlight benefits and concerns with their implementation. Insight into patients', families' and nurses' experiences with bedside handovers can help to identify the most appropriate and safest approach to handovers. INCLUSION CRITERIA The current review considered patients, family members and nurses in the acute care hospital setting. Nurses included licensed nurses, registered nurses, practical nurses, nursing assistants, nurse researchers, and advanced practice nurses. METHODS A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative studies that considered attitudes, beliefs and experiences of patients, families and nurses on patient presence during bedside handover were considered for this review. Papers included in the review were from 1998 to 2017. RESULTS The review included 12 qualitative publications. Key findings were extracted and classified as unequivocal (U) or credible (C). A total of 96 findings were extracted and aggregated into 14 categories. From the 14 categories, five synthesized findings were developed: i) becoming more informed; ii) upholding confidentiality and privacy; iii) varying desire and ability to participate; iv) individualizing patient care; and v) challenges in conducting bedside handovers can be overcome with adaptive practices. CONCLUSIONS This review captured the experiences of patients, families and nurses with patient presence during bedside handovers in a hospital setting. For the most part, patients and families describe bedside handover positively, reporting feeling more informed and engaged in care. This review highlights areas where patients' and nurses' views on bedside reporting may differ, particularly in the areas of desire to participate and the need for confidentiality. Although hospital environments can create challenges in sharing personal patient information at the bedside, these may be overcome through education and by the adoption of a flexible and individualized approach.
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Affiliation(s)
- Rose M McCloskey
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Karen E Furlong
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Linda Hansen
- Department of Information Services and Systems, University of New Brunswick, Saint John, Canada.,The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
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17
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Giardina TD, Royse KE, Khanna A, Haskell H, Hallisy J, Southwick F, Singh H. Health Care Provider Factors Associated with Patient-Reported Adverse Events and Harm. Jt Comm J Qual Patient Saf 2020; 46:282-290. [PMID: 32362355 DOI: 10.1016/j.jcjq.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/31/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients can provide valuable information missing from traditional sources of safety data, thus adding new insights about factors that lead to preventable harm. In this study, researchers determined associations between patient-reported contributory factors and patient-reported harms experienced after an adverse event (AE). METHODS A secondary analysis was conducted of a national sample of patient-reported AEs (surgical, medication, diagnostic, and hospital-acquired infection) gathered through an online questionnaire between January 2010 and February 2016. Generalized logit multivariable regression was used to assess the association between patient-reported contributory factors and patient-reported harms (grouped as nonphysical harm only, physical harm only, physical harm and emotional or financial harm, and all three harms) and adjusted for patient and AE characteristics. RESULTS One third of patients (32.6%) reported experiencing all three harms, 27.3% reported physical harms and one additional harm, 25.5% reported physical harms only, and 14.7% reported nonphysical harms only. Patients reporting all three harms were 2.5 times more likely to have filed a report with a responsible authority (95% confidence interval [CI] = 1.23-5.01) and 3.3 times more likely to have also experienced a surgical complication (95% CI = 1.42-7.51). Odds of reporting problems related to communication between clinician and patients/families or clinician-related behavioral issues was 13% higher in those experiencing all three harm types (95% CI = 1.07-1.19). CONCLUSION Patients' experiences are important to identify safety issues and reduce harm and should be included in patient safety measurement and improvement activities. These findings underscore the need for policy and practice changes to identify, address, and support harmed patients.
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Serrano-Ripoll MJ, Ripoll J, Llobera J, Valderas JM, Pastor-Moreno G, Olry de Labry Lima A, Ricci-Cabello I. Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol. BMJ Open 2019; 9:e031367. [PMID: 31874872 PMCID: PMC7008422 DOI: 10.1136/bmjopen-2019-031367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/03/2019] [Accepted: 11/05/2019] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Despite the enormous potential for adverse events in primary healthcare (PHC), the knowledge about how to improve patient safety in this context is still sparse. We describe the methods for the development and evaluation of an intervention targeted at PHC professionals to improve patient safety in Spanish PHC centres. METHODS AND ANALYSIS The intervention will consist in using the patient reported experiences and outcomes of safety in primary care (PREOS-PC) survey to gather patient-reported experiences and outcomes concerning the safety of the healthcare patients receive in their PHC centres, and feed that information back to the PHC professionals to help them identify opportunities for safer healthcare provision. The study will involve three stages. Stage 1 (developing the intervention) will involve: (i) qualitative study with 40 PHC providers to optimise the acceptability and perceived utility of the proposed intervention; (ii) Spanish translation, cross-cultural adaptation and validation of the PREOS-PC survey; (iii) developing the intervention components; and (iv) developing an online tool to electronically administrate PREOS-PC and automatically generate feedback reports to PHC centres. Stage 2 (piloting the intervention) will involve a 3-month feasibility (one group pre-post) study in 10 PHC centres (500 patients, 260 providers). Stage 3 (evaluating the intervention) will involve: (i) a 12-month, two-arm, two-level cluster randomised controlled trial (1248 PHC professionals within 48 PHC centres; with randomisation at the centre level in a 1:1 ratio) to evaluate the impact of the intervention on patient safety culture (primary outcome), patient-reported safety experiences and outcomes (using the PREOS-PC survey), and avoidable hospitalisations; (ii) qualitative study with 20 PHC providers to evaluate the acceptability and perceived utility of the intervention and identify implementation barriers. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Balearic Islands (CEI IB: 3686/18) with the 1964 Helsinki Declaration and its later amendments. The results will be disseminated in peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER NCT03837912; pre-results.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Psychology, University of Balearic Islands, Palma, Balearic Islands, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Primary Care Prevention and Health Promotion Network, RedIAPP, Barcelona, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- Primary Care Prevention and Health Promotion Network, RedIAPP, Barcelona, Spain
| | - Jose Maria Valderas
- Health Services and Policy Research, Medical School, University of Exeter, Exeter, Devon, UK
| | - Guadalupe Pastor-Moreno
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada, Andalusia, Spain
| | - Antonio Olry de Labry Lima
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada, Andalusia, Spain
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Balearic Islands, Spain
- GRAPP-caIB, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health. CIBERESP, Madrid, Spain
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Sahlström M, Partanen P, Turunen H. Patient-reported experiences of patient safety incidents need to be utilized more systematically in promoting safe care. Int J Qual Health Care 2019; 30:778-785. [PMID: 29668942 DOI: 10.1093/intqhc/mzy074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 04/07/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To analyze patient safety incidents (PSIs) reported by patients and their use in Finnish healthcare organizations. Study Design Cross-sectional study. Setting About 15 Finnish healthcare organizations ranging from specialized hospital care to home care, outpatient and inpatient clinics, and geographically diverse areas of Finland. Participants The study population included all Finnish patients who had voluntarily reported PSI via web-based system in 2009-15. Main Outcome Measure(s) Quantitative analysis of patients' safety reports, inductive content analysis of patients' suggestions to prevent the reoccurrence incidents and how those suggestions were used in healthcare organizations. Results Patients reported 656 PSIs, most of which were classified by the healthcare organizations' analysts as problems associated with information flow (32.6%) and medications (18%). Most of the incidents (65%) did not cause any harm to patients. About 76% of the reports suggested ways to prevent reoccurrence of PSIs, most of which were feasible, system-based amendments of processes for reviewing or administering treatment, anticipating risks or improving diligence in patient care. However, only 6% had led to practical implementation of corrective actions in the healthcare organizations. Conclusions The results indicate that patients report diverse PSIs and suggest practical systems-based solutions to prevent their reoccurrence. However, patients' reports rarely lead to corrective actions documented in the registering system, indicating that there is substantial scope to improve utilization of patients' reports. There is also a need for strong patient safety management, including willingness and commitment of HCPs and leaders to learn from safety incidents.
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Affiliation(s)
- Merja Sahlström
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland.,Ylä-Savo SOTE Joint Municipal Authority, Finland
| | - Pirjo Partanen
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Kuopio University Hospital, Kuopio, Finland
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Stocks SJ, Donnelly A, Esmail A, Beresford J, Luty S, Deacon R, Danczak A, Mann N, Townsend D, Ashley J, Gamble C, Bowie P, Campbell SM. Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain. BMJ Open 2018; 8:e020952. [PMID: 29899057 PMCID: PMC6009615 DOI: 10.1136/bmjopen-2017-020952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful. DESIGN Population-level survey. SETTING Great Britain. PARTICIPANTS A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016. MAIN OUTCOME MEASURES Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public. RESULTS 3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful. CONCLUSIONS This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care.
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Affiliation(s)
- Susan Jill Stocks
- Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ailsa Donnelly
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Aneez Esmail
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Beresford
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Sarah Luty
- Medical Directorate, NHS Greater Glasgow and Clyde, NHS Education for Scotland, Glasgow, UK
| | | | - Avril Danczak
- Central and South Manchester Specialty Training Programme for General Practice, Health Education England North West (HEENWE) Education and Research Centre, Wythenshawe Hospital, Manchester, UK
| | - Nicola Mann
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - David Townsend
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | - Carolyn Gamble
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Paul Bowie
- NHS Education for Scotland, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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21
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Stocks SJ, Donnelly A, Esmail A, Beresford J, Gamble C, Luty S, Deacon R, Danczak A, Mann N, Townsend D, Ashley J, Bowie P, Campbell SM. Development and piloting of a survey to estimate the frequency and nature of potentially harmful preventable problems in primary care from a UK patient's perspective. BMJ Open 2018; 8:e017786. [PMID: 29431124 PMCID: PMC5829776 DOI: 10.1136/bmjopen-2017-017786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To design and pilot a survey to be used at the population level to estimate the frequency of patient-perceived potentially harmful preventable problems occurring in UK primary care. To explore the nature of the problems, patient-suggested strategies for prevention and opinions of clinicians and the public regarding the potential for harm. DESIGN A survey was codesigned by three members of the public and one researcher and piloted through public and patient involvement and engagement networks. SETTING Self-selected sample of the UK population. PARTICIPANTS 977 members of the public accessed the online survey during October and November 2015. PRIMARY OUTCOME MEASURES Respondent feedback about the ease of completion of the survey, quality of responses in terms of review by clinicians and members of the public, preliminary estimates of the frequency and nature of patient-perceived potentially harmful problems occurring in the last 12 months. RESULTS 638 (65%) members of the public completed the survey and few respondents reported any difficulty in understanding or completing the survey. 132 (21%) respondents reported experiencing a potentially harmful preventable problem during the past 12 months and 108 (82%) of these respondents provided a description that was adequate for at least one clinician to form an opinion about the potentially harmful problem. Respondents were older than the UK generally, more likely to work or volunteer in the healthcare sector and tended to use primary care more frequently but their confidence and trust in their own general practitioner (GP) was similar to that of the UK population as measured by the annual English GP patient survey. CONCLUSIONS The survey was acceptable to patients and mostly provided data of sufficient quality for review by clinicians and members of the public. It is now ready to use at a population level to estimate the frequency and nature of potentially harmful preventable problems in primary care from a patient's perspective.
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Affiliation(s)
- Susan J Stocks
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ailsa Donnelly
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Aneez Esmail
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Beresford
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Carolyn Gamble
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sarah Luty
- General Practitioner NHS Greater Glasgow and Clyde, Medical Directorate, NHS Education for Scotland, Glasgow, Scotland
| | | | - Avril Danczak
- Central and South Manchester Specialty Training Programme for General Practice, Health Education England North West (HEENWE) Education and Research Centre, Wythenshawe Hospital, Manchester, UK
| | - Nicola Mann
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Townsend
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | - Paul Bowie
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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22
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Ricci‐Cabello I, Saletti‐Cuesta L, Slight SP, Valderas JM. Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire. Health Expect 2017; 20:961-972. [PMID: 28244631 PMCID: PMC5600214 DOI: 10.1111/hex.12537] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a growing interest in identifying strategies to achieve safer primary health-care provision. However, most of the research conducted so far in this area relies on information supplied by health-care providers, and limited attention has been paid to patients' perspectives. OBJECTIVE To explore patients' experiences and perceptions of patient safety in English general practices with the aim of eliciting patient-centred recommendations for improving patient safety. METHODS The Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire was sent to a random sample of 6736 primary care users registered in 45 English practices. We conducted a qualitative content analysis of responses to seven open-ended items addressing patients' experiences of safety problems, lessons learnt as a result of such experiences and recommendations for safer health care. RESULTS A total of 1244 (18.4%) participants returned completed questionnaires. Of those, 678 (54.5%) responded to at least one open-ended question. Two main themes emerged as follows: (i) experiences of safety problems and (ii) good practices and recommendations to improve patient safety in primary care. Most frequent experiences of safety problems were related to appointments, coordination between providers, tests, medication and diagnosis. Patients' responses to these problems included increased patient activation (eg speaking up about concerns with their health care) and avoidance of unnecessary health care. Recommendations for safer health care included improvements in patient-centred communication, continuity of care, timely appointments, technical quality of care, active monitoring, teamwork, health records and practice environment. CONCLUSION This study identified a number of patient-centred recommendations for improving patient safety in English general practices.
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Affiliation(s)
| | - Lorena Saletti‐Cuesta
- National Scientific and Technical Research Council (CONICET)Culture and Society Research and Study Centre (CIECS‐CONICET‐UNC)CórdobaArgentina
| | - Sarah P. Slight
- Division of PharmacySchool of Medicine, Pharmacy and HealthDurham UniversityStockton on TeesUK
- Department of PharmacyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastleUK
- Division of General Internal MedicineCentre for Patient Safety Research and PracticeBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Jose M. Valderas
- Health Services and Policy Research GroupPatient Centred CareUniversity of Exeter Collaboration for Academic Primary Care (APEx)University of Exeter Medical SchoolUniversity of ExeterExeterUK
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