1
|
Silva AEBDC, Sousa TP, Guimaraes RA, Pagotto V, de Lima JC, de Sousa MRG, Bernardes CA. Validation of the patient reported experiences and outcomes of safety in primary care compact Form Brazil. PLoS One 2024; 19:e0305414. [PMID: 38950012 PMCID: PMC11216591 DOI: 10.1371/journal.pone.0305414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Compact Form Brazil. METHODS A methodological study was conducted with 281 adult Primary Health Care users. Data collection took place online. Confirmatory Factor Analysis (CFA) was used to evaluate the psychometric properties of the PREOS-PC after the process of cross-cultural adaptation to the Brazilian context. Internal consistency was evaluated through Cronbach's alpha coefficient (α) and McDonald's omega coefficient (ω). RESULTS The sample consisted of 73.3% women. The mean age was 36.1 years (SD = 12.2). Of the 23 items of the PREOS-PC that were eligible for CFA, a model with four correlated domains and 16 items presented satisfactory fit indexes. The domains were Practice Activation (PrA) (four items), Patient Activation (PaA) (two items), Experiences of patient safety events (EPaS) (five items) and Outcomes of patient safety (OPaS) (six items). One domain (GPeS) presented one question with a 0 to 10 response scale and two open questions, which cannot be inserted in the CPA due to the nature of the items, but can be included in the application of the scale, being evaluated individually. In this factorial model, five items (EPaS2, EPaS3, EPaS4, EPaS5, EPaS6 and EPaS8) presented factor loadings ≤ 0.30. The α and ω values demonstrated good internal consistency for all domains of the PREOS-PC. CONCLUSIONS The Brazilian version of the PREOS-PC Compact Form Brazil composed of four domains (PrA, PA, EPaS and OPaS) and 16 items presented evidence of validation of its psychometric properties and can be used to evaluate the experiences and results of patient safety in Primary Health Care in the Brazilian context.
Collapse
Affiliation(s)
| | | | - Rafael Alves Guimaraes
- Nursing School, Federal University of Goiás, Goiânia, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Valéria Pagotto
- Nursing School, Federal University of Goiás, Goiânia, Brazil
| | | | | | | |
Collapse
|
2
|
Alasqah I. Patients' Perceptions of Safety in Primary Healthcare Settings: A Cross-Sectional Study in the Qassim Region of Saudi Arabia. Healthcare (Basel) 2023; 11:2141. [PMID: 37570381 PMCID: PMC10419299 DOI: 10.3390/healthcare11152141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
This study assessed patients' perceptions of safety and experiences in primary healthcare in the Qassim region of Saudi Arabia. Between July and September 2022, 730 patients from primary healthcare centers were surveyed using a multi-staged cluster random sampling approach. The Patient-Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was used to measure patients' perceived safety and experience in primary healthcare settings within the past year. Descriptive analyses were performed to report patients' perceived safety experiences. The statistical analysis examined individual items and scales. A considerable proportion of patients reported encountering safety problems, ranging from 11% (vaccine-related) to 27% (diagnosis-related). Diagnostic errors were the most common perceived safety problem (26.7%), followed by communication issues (24.1%) and medication errors (16.3%). Between 26% and 40% experienced harm, including financial problems (40%), increased care needs (32.4%), physical health issues (32%), limitations in activities (30.6%), increased healthcare needs (30.2%), and mental health concerns (26.8%). Patient-reported safety experiences reported in our study offer valuable insights into primary care safety in Saudi Arabia. Collecting routine patient feedback is crucial for addressing identified safety problems and implementing standardized procedures.
Collapse
Affiliation(s)
- Ibrahim Alasqah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Albukairiyah 52741, Saudi Arabia
| |
Collapse
|
3
|
Morris RL, Giles S, Campbell S. Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide. Health Expect 2023; 26:630-639. [PMID: 36645147 PMCID: PMC10010084 DOI: 10.1111/hex.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involving patients is a key premise of national and international policies on patient safety, which requires understanding how patients or carers want to be involved and developing resources to support this. This paper examines patients' and carers' views of being involved in patient safety in primary care and their views of potentially using a co-designed patient safety guide for primary care (PSG-PC) to foster both involvement and their safety. METHODS A qualitative study using semistructured face-to-face interviews with 18 patients and/or carers in primary care. Interviews were transcribed and analysis was conducted using an inductive thematic approach. RESULTS Overall participants expressed enthusiasm for the PSG-PC as a tool to support patients and carers to be involved in patient safety in primary care. However, for some participants being involved in patient safety was seen as taking on the role of General Practitioner and had the potential to add an additional workload for patients. Participants' willingness or ability to be involved in patient safety was influenced by a range of factors including an invisible, often underacknowledged role of everyday safety for patients' interactions with primary care; the levels of involvement that patients wanted in their care and safety and the work of embedding the PSG-PC for patients into their routine interactions with primary care. Participants identified components of the PSG-PC that would be useful to them, in particular, if they had a responsibility for caring for a family member if they had more complex care or long-term conditions. CONCLUSION Involving patients and carers in patient safety needs a tailored and personalized approach that enables patients and carers to use resources like the PSG-PC routinely and helps challenge assumptions about their willingness and ability to be involved in patient safety. Doing so would raise awareness of opportunities to be involved in safety in line with personal preference. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement were central to the research study. This included working in partnership to develop the PSG-PC with patients and carers and throughout our study including in the design of the study, recruiting participants, interpretation of findings.
Collapse
Affiliation(s)
- Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Foster C, Kaat AJ, Shaunfield S, Lin E, Coleman C, Storey M, Morales L, Davis MM. PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality. Acad Pediatr 2022; 22:1510-1519. [PMID: 35439604 DOI: 10.1016/j.acap.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC). METHODS A national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers. RESULTS The final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31-4 to 43-4 (0-4 scale). CONCLUSIONS PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.
Collapse
Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Aaron J Kaat
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sara Shaunfield
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elaine Lin
- Division of General Pediatrics, Department of Pediatrics (E Lin), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cara Coleman
- Family Voices National (C Coleman), Lexington, Mass
| | - Margaret Storey
- Ann & Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Luis Morales
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Stahl K, Reisinger A, Groene O. Assessing patient experience with patient safety in primary care: development and validation of the ASK-ME-questionnaire. BMJ Open 2022; 12:e049237. [PMID: 35387804 PMCID: PMC8987793 DOI: 10.1136/bmjopen-2021-049237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To develop and test the validity and reliability of a tool measuring patient experiences with patient safety in ambulatory care that is suitable for routine use in general practitioner and specialist practices. DESIGN Instrument development was based on a literature review, a 3-round Delphi survey with a multidisciplinary expert panel and cognitive interviews with patients. The instrument was piloted in 22 practices using a cross-sectional survey. Exploratory (EFA) and confirmatory factor analysis (CFA) were performed to test construct validity. Internal consistency and the ability of the questionnaire to differentiate between selected subgroups and at the level of individual practices was examined. SETTING General practitioner and specialist practices. PARTICIPANTS Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. RESULTS The final ASK-ME-questionnaire consisted of 22 items covering 5 theoretical dimensions. A total of 3042 patients (71.1%) completed the questionnaire. Median item non-response rate was 4.2% (IQR 3.4%-4.7%). EFA yielded 3 factors comprising 14 items explaining 64.8% of the variance representing contributing factors to patient safety incidents. CFA confirmed the factorial structure suggested by EFA. The model fit the data satisfactorily (comparative fit index=0.92, root mean square error of approximation=0.08, standardised root mean square residual=0.08). Internal consistency values ranged from 0.7 to 0.9. Discriminant validity was supported by significant differences between patients of different age and differences in self-reported health status. The factors distinguished well between practices. CONCLUSION The ASK-ME-questionnaire showed good psychometric properties. It is suitable for routine use in patient safety measurement and improvement systems in ambulatory care. Further research is required to adequately assess number and type of experienced events in routine measurements.
Collapse
Affiliation(s)
- Katja Stahl
- Research & Innovation, Optimedis AG, Hamburg, Germany
- Midwifery Science, Universität zu Lübeck, Lubeck, Germany
| | | | | |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
9
|
Madden C, Lydon S, O'Dowd E, Murphy AW, O'Connor P. A Systematic Review of Patient-Report Safety Climate Measures in Health Care. J Patient Saf 2022; 18:e51-e60. [PMID: 32345810 DOI: 10.1097/pts.0000000000000705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients are a valuable, yet underutilized source of information for safety measurement and improvement in health care. The aim of this review was to identify patient-report safety climate (SC) measures described in the literature, analyze the included items to consider their alignment with previously established SC domains, evaluate their validity and reliability, and make recommendations for best practice in using patient-report measures of SC in health care. METHODS Searches were conducted, with no limit on publication year, using MEDLINE, EMBASE, CINAHL, PsycINFO, and Academic Search Complete in November 2019. Reference lists of included studies and existing reviews were also screened. English-language, peer-reviewed studies that described the development or use of a patient-report measure to assess SC in health care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool. RESULTS A total of 5060 studies were screened, with 44 included. Included studies described 31 different SC measures. There was much variability in the coverage of SC domains across included measures. Poor measure quality was marked by inadequacies in the testing and reporting of validity and reliability. There was also a lack of usability testing among measures. CONCLUSIONS This review identified the extant patient-reported SC measures in health care and demonstrated significant variance in their coverage of SC domains, validity and reliability, and usability. Findings suggest a pressing need for a stand-alone measure that has a high validity and reliability, and assess core SC domains from the patient perspective, particularly in primary care.
Collapse
|
10
|
Madden C, Lydon S, Murphy AW, O'Connor P. Patients' perception of safety climate in Irish general practice: a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:257. [PMID: 34961484 PMCID: PMC8710927 DOI: 10.1186/s12875-021-01603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients' perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC? METHODS The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses. RESULTS A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care. CONCLUSION Our findings indicate that despite being under-utilised, patients' perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.
Collapse
Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland.
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Andrew W Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| |
Collapse
|
11
|
Stahl K, Groene O. ASK ME!-Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey. PLoS One 2021; 16:e0259252. [PMID: 34851966 PMCID: PMC8635405 DOI: 10.1371/journal.pone.0259252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Routine measurement of patient safety from the patients’ perspective receives increasing attention as an important component of safety measurement systems. The aim of this study was to examine patients’ experience with patient safety in ambulatory care and the results’ implications for routine patient safety measurement in ambulatory care. Design Cross-sectional mixed-mode survey. Setting General practitioner and specialist practices. Participants Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. Methods A 22-item-questionnaire was completed in the practice or at home either on paper or online. Multivariate logistic regression was used to analyse the influence of survey mode and patient characteristics on patient experience with patient safety. Results The overall response rate was 71.1%. Most patients completed the questionnaire on site (76.6%) and on paper (96.1%). Between 30.1% to 68.5% of the respondents report the most positive option for patient experience with the main domains of patient safety. A total of 2.9% of patients reported having experienced a patient-safety event (PSE) during the last 12 months. Patients who filled in the questionnaire off site were more likely to report negative experiences for the scales communication & information (OR 1.2, 95% CI 1.0–1.5), rapport & participation (OR 1.4, 95% CI 1.1–1.7) and access (OR 1.3, 95% CI 0.9–1.4) than those who completed it on site. Those who chose a paper questionnaire were more likely to report negative experiences for all five scales compared to web responders. Conclusion Routine measurement of patient experience with factors contributing to the occurrence of PSEs can achieve high response rates by offering flexible participation options. Results gained from mixed-mode surveys need to take mode-effects into account when interpreting and using the results. Further research is needed in how to adequately assess number and type of experienced events in routine measurements.
Collapse
Affiliation(s)
- Katja Stahl
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
- * E-mail:
| | - Oliver Groene
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
| |
Collapse
|
12
|
Ruiz Pérez R, Ruiz-Montero R, Ruiz Moruno J, Guzmán Herrador B, Barranco Quintana JL, Salcedo Leal I. [Patient safety: Patients perception at primary care level at an urban healthcare district]. Semergen 2021; 47:465-471. [PMID: 34147347 DOI: 10.1016/j.semerg.2021.05.006] [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: 02/21/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area. MATERIAL AND METHODS Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed. RESULTS Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician. CONCLUSIONS The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.
Collapse
Affiliation(s)
- R Ruiz Pérez
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - R Ruiz-Montero
- UGC Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
| | - J Ruiz Moruno
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Centro de Salud de Atención Primaria Aeropuerto, Servicio Andaluz de Salud, Córdoba, España
| | - B Guzmán Herrador
- UGC Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - J L Barranco Quintana
- UGC Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - I Salcedo Leal
- UGC Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| |
Collapse
|
13
|
Hernan AL, Giles SJ, Carson-Stevens A, Morgan M, Lewis P, Hind J, Versace V. Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England. BMJ Open 2021; 11:e042551. [PMID: 33926976 PMCID: PMC8094340 DOI: 10.1136/bmjopen-2020-042551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement. OBJECTIVE The aim of this study was to characterise the nature of patient-reported safety incidents in primary care. DESIGN Secondary analysis of two cross sectional studies. PARTICIPANTS Adult patients from Australian and English primary care settings. MEASURES Patients' self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented. RESULTS A total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent. CONCLUSIONS The nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.
Collapse
Affiliation(s)
- Andrea L Hernan
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Sally J Giles
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
- Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Penny Lewis
- Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - James Hind
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Vincent Versace
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Geelong, Victoria, Australia
| |
Collapse
|
14
|
Abstract
OBJECTIVE Major gaps remain in our understanding of primary care patient safety. We describe a toolkit for measuring patient safety in family practices. METHODS Six tools were used in 46 practices. These tools were as follows: National Health Service Education for Scotland Trigger Tool, National Health Service Education for Scotland Medicines Reconciliation Tool, Primary Care Safequest, Prescribing Safety Indicators, Patient Reported Experiences and Outcomes of Safety in Primary Care, and Concise Safe Systems Checklist. RESULTS Primary Care Safequest showed that most practices had a well-developed safety climate. However, the trigger tool revealed that a quarter of events identified were associated with moderate or substantial harm, with a third originating in primary care and avoidable. Although medicines reconciliation was undertaken within 2 days in more than 70% of cases, necessary discussions with a patient/carer did not always occur. The prescribing safety indicators identified 1435 instances of potentially hazardous prescribing or lack of recommended monitoring (from 92,649 patients). The Concise Safe Systems Checklist found that 25% of staff thought that their practice provided inadequate follow-up for vulnerable patients discharged from hospital and inadequate monitoring of noncollection of prescriptions. Most patients had a positive perception of the safety of their practice although 45% identified at least one safety problem in the past year. CONCLUSIONS Patient safety is complex and multidimensional. The Patient Safety Toolkit is easy to use and hosted on a single platform with a collection of tools generating practical and actionable information. It enables family practices to identify safety deficits that they can review and change procedures to improve their patient safety across a key sets of patient safety issues.
Collapse
|
15
|
Morris RL, Ruddock A, Gallacher K, Rolfe C, Giles S, Campbell S. Developing a patient safety guide for primary care: A co-design approach involving patients, carers and clinicians. Health Expect 2021; 24:42-52. [PMID: 33142022 PMCID: PMC7879544 DOI: 10.1111/hex.13143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients and carers should be actively involved in patient safety and empowered to use person-centred approaches where they are asked to both identify safety concerns and partner in preventing them. OBJECTIVES The aim of this study was to co-design a patient safety guide for primary care (PSG-PC) to support patients and carers to address key patient safety questions and identify key points where they can make their care safer. The objectives were to i) identify when and how patients and carers can be involved in primary care patient safety, and ii) identify the relevant information to include in the PSG-PC. DESIGN An experience-based co-design approach. SETTING AND PARTICIPANTS We conducted three workshops with patients, carers, community pharmacists and general practitioners to develop and refine the PSG-PC. RESULTS Participants identified both explicit and implicit issues of primary care patient safety especially relating to technical and relational components of involving patients and carers. The importance of communication, understanding roles and responsibilities, and developing partnerships between patients and health-care providers were considered essential for actively involving patients in patient safety. Co-developing the PSG-PC provided insight to improve care to develop the PSG-PC. DISCUSSION The PSG-PC is the first guide to be developed for primary care, co-designed with patients, carers, general practitioners and pharmacists. The PSG-PC will support patients and carers to partner with health-care professionals to improve patient safety addressing international and national priorities to continuously improve patient safety.
Collapse
Affiliation(s)
- Rebecca L. Morris
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Angela Ruddock
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Kay Gallacher
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Carly Rolfe
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research CentreFaculty of Biology, Medicine and HealthDivision of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Aoki T, Watanuki S. Multimorbidity and patient-reported diagnostic errors in the primary care setting: multicentre cross-sectional study in Japan. BMJ Open 2020; 10:e039040. [PMID: 32819954 PMCID: PMC7440713 DOI: 10.1136/bmjopen-2020-039040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES There is lack of evidence for the association between multimorbidity and diagnostic errors. Information on diagnostic errors from patients' perspectives is crucial to improve the diagnostic process. In this study, we aimed to investigate patient-reported diagnostic errors and to examine the relationship between multimorbidity and patient-reported diagnostic errors in the primary care setting. DESIGN Multicentre cross-sectional study. SETTING A primary care practice-based research network in Japan (25 primary care facilities). PARTICIPANTS Adult outpatients filled out a standardised questionnaire. PRIMARY OUTCOME MEASURE Patient-reported diagnostic errors. RESULTS Data collected from 1474 primary care outpatients were analysed. The number of participants who reported diagnostic errors was 57 (3.9%). Most of the missed diagnoses were common conditions in primary care, such as cancer, dermatitis and hypertension. After adjustment for possible confounders and clustering within facilities, multimorbidity was positively associated with patient-reported diagnostic errors (adjusted OR=1.83, 95% CI 1.01 to 3.31). The results of the sensitivity analysis were consistent with those of the primary analysis. CONCLUSIONS The present study showed a lower proportion of patients reporting experiences of diagnostic errors in primary care than those reported in previous studies in other countries. However, patients with multimorbidity are more likely to report diagnostic errors in primary care; thus, further research is necessary to improve the diagnostic process for patients with multimorbidity.
Collapse
Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Watanuki
- Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| |
Collapse
|
18
|
Boylan AM, Turk A, van Velthoven MH, Powell J. Online patient feedback as a measure of quality in primary care: a multimethod study using correlation and qualitative analysis. BMJ Open 2020; 10:e031820. [PMID: 32114461 PMCID: PMC7050381 DOI: 10.1136/bmjopen-2019-031820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To ascertain the relationship between online patient feedback and the General Practice Patient Survey (GPPS) and the Friends and Family Test (FFT). To consider the potential benefit it may add by describing the content of public reviews found on NHS Choices for all general practices in one Clinical Commissioning Group in England. DESIGN Multimethod study using correlation and thematic analysis. SETTING 1396 public online reviews and ratings on NHS Choices for all General Practices (n=70) in Oxfordshire Clinical Commissioning Group in England. RESULTS Significant moderate correlations were found between the online patient feedback and the GPPS and the FFT. Three themes were developed through the qualitative analysis: (1) online feedback largely provides positive reinforcement for practice staff; (2) online feedback is used as a platform for suggesting service organisation and delivery improvements; (3) online feedback can be a source of insight into patients' expectations of care. These themes illustrate the wide range of topics commented on by patients, including their medical care, relationships with various members of staff, practice facilities, amenities and services in primary care settings. CONCLUSIONS This multimethod study demonstrates that online feedback found on NHS Choices is significantly correlated with established measures of quality in primary care. This suggests it has a potential use in understanding patient experience and satisfaction, and a potential use in quality improvement and patient safety. The qualitative analysis shows that this form of feedback contains helpful information about patients' experiences of general practice that provide insight into issues of quality and patient safety relevant to primary care. Health providers should offer patients multiple ways of offering feedback, including online, and should have systems in place to respond to and act on this feedback.
Collapse
Affiliation(s)
- Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amadea Turk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Giles SJ, Parveen S, Hernan AL. Validation of the Primary Care Patient Measure of Safety (PC PMOS) questionnaire. BMJ Qual Saf 2019; 28:389-396. [PMID: 30337498 PMCID: PMC6560461 DOI: 10.1136/bmjqs-2018-007988] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. METHOD 490 adult patients in nine primary care practices in Greater Manchester, UK, completed the PC PMOS. Practice staff (n = 81) completed a survey on patient safety culture to assess convergent validity. Confirmatory factor analysis (CFA) assessed the construct validity and internal reliability of the PC PMOS domains and items. A multivariate analysis of variance was conducted to assess discriminant validity, and Spearman correlation was conducted to establish test-retest reliability. RESULTS Initial CFA results showed data did not fit the model well (a chi-square to df ratio (CMIN/DF) = 5.68; goodness-of-fit index (GFI) = 0.61, CFI = 0.57, SRMR = 0.13 and root mean square error of approximation (RMSEA) = 0.10). On the basis of large modification indices (>10), standardised residuals >± 2.58 and assessment of item content; 22 items were removed. This revised nine-factor model (28 items) was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04 and RMSEA = 0.05). New factors demonstrated good internal reliability with average inter-item correlations ranging from 0.20 to 0.70. The PC PMOS demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, p < 0.001) and showed some association with practice staff safety score (convergent validity) but failed to reach statistical significance (r = -0.64, k = 9, p = 0.06). CONCLUSION This study led to a reliable and valid 28-item PC PMOS. It could enhance or complement current data collection methods used in primary care to identify and prevent error.
Collapse
Affiliation(s)
- Sally J Giles
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Sahdia Parveen
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Andrea L Hernan
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|