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Cheikh-Moussa K, Caro Mendivelso J, Carrillo I, Astier-Peña MP, Olivera G, Silvestre C, Nuín M, Mira JJ. Frequency and estimated costs of ten low-value practices in the Spanish Primary Care: a retrospective study. Expert Opin Drug Saf 2022; 21:995-1003. [PMID: 35020555 DOI: 10.1080/14740338.2022.2026924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The frequency of low-value practices (LVPs) in the healthcare system is a worldwide challenge. Far less is known about the related extra cost. This study aimed to evaluate the LVPs trend in Spanish primary care (PC), its frequency in both sexes, and estimate its related extra cost. METHODS A multicentric, retrospective, and national research project was conducted. Ten LVPs highly frequent and potentially harmful for patients were analyzed. Algorithms were applied to collect the data from 28,872,851 episodes registered into national databases (2015-2017). Cost estimation was made. RESULTS LVPs registered a total of 7,160,952 (26.5%) episodes plus a total of 259,326 avoidable PSA screening tests. In adults, a high frequency was found for prescription of 1g paracetamol >3 days, antibiotics for acute bronchitis (unconfirmed comorbidity), and benzodiazepines in patients >65 years with insomnia. Women received more jeopardizing practices (p≤0.001). Pediatrics presented a downward of antibiotic and paracetamol-ibuprofen prescription combination. The estimated extra cost was close to €292 million (2.8% of the total cost in PC). CONCLUSION LVPs reduction during the analyzed period was moderate compared to studies following 'Choosing Wisely list' of LVPs and must improve to reduce patient risk and the extra related costs.
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Affiliation(s)
- Kamila Cheikh-Moussa
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Spain
| | - Johanna Caro Mendivelso
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Irene Carrillo
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - María Pilar Astier-Peña
- Family and Community Medicine, Universitas Health Centre, Zaragoza I Sector, Aragonese Health Service (SALUD), Zaragoza, Spain.,University of Zaragoza, Aragon Health Research Institute (IISA), Zaragoza, Spain
| | | | - Carmen Silvestre
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - Marian Nuín
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain.,Health District Alicante-Sant Joan, Alicante, Spain.,REDISSEC, Spain
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Montano MF, Mehdi H, Nash DB. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement. Am J Med Qual 2016; 31:29S-43S. [PMID: 27535940 DOI: 10.1177/1062860616664164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.
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Affiliation(s)
| | - Harshal Mehdi
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - David B Nash
- Jefferson College of Population Health, Philadelphia, PA
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Lee NJ, Cho E, Bakken S. Identification of Hypertension Management-related Errors in a Personal Digital Assistant-based Clinical Log for Nurses in Advanced Practice Nurse Training. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 4:19-31. [PMID: 25030790 DOI: 10.1016/s1976-1317(10)60003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 02/02/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. METHOD We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistant-based clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. RESULT Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. CONCLUSION The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies.
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Affiliation(s)
- Nam-Ju Lee
- Full-time Instructor and Researcher, Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, Korea
| | - Eunhee Cho
- Assistant Professor and Researcher, Nursing Policy Research Institute Yonsei University College of Nursing, Seoul, Korea
| | - Suzanne Bakken
- Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University School of Nursing, New York, USA
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Aranaz-Andres JM, Aibar C, Limon R, Mira JJ, Vitaller J, Agra Y, Terol E. A study of the prevalence of adverse events in primary healthcare in Spain. Eur J Public Health 2011. [DOI: 10.1093/eurpub/ckr168] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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González-Formoso C, Martín-Miguel MV, Fernández-Domínguez MJ, Rial A, Lago-Deibe FI, Ramil-Hermida L, Pérez-García M, Clavería A. Adverse events analysis as an educational tool to improve patient safety culture in primary care: a randomized trial. BMC FAMILY PRACTICE 2011; 12:50. [PMID: 21672197 PMCID: PMC3142500 DOI: 10.1186/1471-2296-12-50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/14/2011] [Indexed: 11/16/2022]
Abstract
Background Patient safety is a leading item on the policy agenda of both major international health organizations and advanced countries generally. The quantitative description of the phenomena has given rise to intense concern with the issue in institutions and organizations, leading to a number of initiatives and research projects and the promotion of patient safety culture, with training becoming a priority both in Spain and internationally. To date, most studies have been conducted in a hospital setting, even though primary care is the type most commonly used by the public, in our experience. Our study aims to achieve the following: - Assess the registry of adverse events as an education tool to improve patient safety culture in the Family and Community Teaching Units of Galicia. - Find and analyze educational tools to improve patient safety culture in primary care. - Evaluate the applicability of the Hospital Survey on Patient Safety Culture by the Agency for Healthcare Research and Quality, Spanish version, in the context of primary health care. Design and methods Discussion The most significant limitations on the project are related to selecting a tool to measure the safety environment, the training calendar of residents in Family and Community Medicine in last year of studies and the no-answer bias inherent to research conducted through self-administered surveys. The development and application of a safety culture in the health sector, specifically in primary care, is as yet limited. Thus, identifying the strengths and weaknesses in the safety environment may assist in designing strategies for improvement in the primary care health centers of our region. Trial registration ISRCTN: ISRCTN41911128
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Affiliation(s)
- Clara González-Formoso
- Quality Unit, Vigo Primary Care Region, Galician Health Service, (Rosalía de Castro 21-23), Vigo (36201), Spain.
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Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A Randomized Trial of the Effectiveness and Efficiency of Interventions to Reduce Potential Drug Interactions in Primary Care. Am J Med Qual 2011; 26:145-53. [DOI: 10.1177/1062860610380898] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Juan C. Ruiz
- Murcia Health Service, Murcia Health Area, Murcia, Spain
| | | | - Angeles Ariza
- Murcia Health Service, Murcia Health Area, Murcia, Spain
| | - Belen Aguilera
- Murcia Health Service, Murcia Health Area, Murcia, Spain
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López-Picazo JJ, Ruiz JC, Sánchez JF, Ariza A, Aguilera B. [A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine]. Aten Primaria 2011; 43:254-62. [PMID: 21216049 DOI: 10.1016/j.aprim.2010.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/13/2010] [Accepted: 06/04/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To effectively locate the drugs most implicated in severe interactions as a basis of designing actions to improve patient safety in Primary Care. DESIGN Cross-sectional study of prescriptions using the Primary Care computerised medical records database (OMI-PC). SETTING Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants). PARTICIPANTS There are 362,271 patients over 14 years-old available in the OMI-PC and are assigned to a doctor who uses the OMI-PC regularly. MAIN MEASUREMENTS We analysed the drugs that each patient could be taking, looking for severe interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1] the probability that a non-selected patient may be taking a particular drug and [2] the probability that a drug may produce a severe interaction. With this, we estimated the risk of producing a severe interaction for each drug, which was converted into a 5 point logarithmic scale. RESULTS We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified 466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%). In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value: omeprazole, diazepam, acenocoumarol, ibuprofen and calcium. CONCLUSIONS e-PIG is a logarithmic expression of the risk that prescribing a particular drug may produce a severe interaction in a determined setting and time. Its monitoring could become a prioritisation element that may assist the design of strategies for improving the safety of the use of drugs.
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Affiliation(s)
- Julio J López-Picazo
- Médico de Familia, Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, España.
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Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazaro D, Sanz GR. Prevalence and typology of potential drug interactions occurring in primary care patients. Eur J Gen Pract 2010; 16:92-9. [PMID: 20504263 DOI: 10.3109/13814788.2010.481709] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. METHODS Cross-sectional descriptive study. SETTING Two areas in Spain comprising 715,661 inhabitants. PATIENTS 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. RESULTS On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. CONCLUSIONS 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.
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Teresa Gea-Velázquez de Castro M, Aranaz-Andrés JM. Utilidad de la guía de cribado del estudio ENEAS en un hospital de atención a enfermos pluripatológicos. Med Clin (Barc) 2010; 135 Suppl 1:24-30. [DOI: 10.1016/s0025-7753(10)70017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Moskowitz EJ, Nash DB. Teaching Trainees the Tenets of Quality and Safety: An Annotated Bibliography. Am J Med Qual 2009; 24:333-43. [DOI: 10.1177/1062860609336325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - David B. Nash
- Jefferson School of Population Health, Philadelphia, Pennsylvania,
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Luces y sombras en la seguridad del paciente: estudio y desarrollo de estrategias. Informe SESPAS 2008. GACETA SANITARIA 2008; 22 Suppl 1:198-204. [DOI: 10.1016/s0213-9111(08)76093-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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