Future research directions for patient safety in primary care

Michel Wensing Wim VerstappenSander Gaal

Aims of this workshop

1.To provide ideas and inspiration for research on patient safety in

primary care

2.To identify shared interests and explore opportunities for

collaboration

3.To inform the research agenda in the field and guide research

funders

Outline

1. Introduction

2. Aspects of primary care to be targeted (intro: Sander Gaal)

3. Interventions/measures to be developed (intro: Wim Verstappen)

4. Experiences in research funding across countries

Structure of group work

1.Clarification and individual completion of questionnaire (10 min)

2.Moderated discussion in group (40-60 min)

3.Add/change responses to questionnaires individually (10 min)

4.Provide complete questionnaire (1 min)

5.Plenary discussion (not feedback from all groups) (10-30 min)

Create groups

Session 1: 9.10 – 10.40 hours

Session 2: 11.00-12.30 hours

Outline

1. Introduction

2. Aspects of primary care to be targeted (intro: Sander Gaal)

3. Interventions/measures to be developed (intro: Wim Verstappen)

4. Experiences in research funding across countries

Patient safety is a very broad definition (29 practitioners mentioned 274 different items)

(Scientific) definitions were not mentioned

Most named: medication safety and telephonic accessibility

When an incident occurred; most GPs took an ‘ad hoc’ improvement

Patient safety according to GPs

Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.J Eval Clin Pract. 2010 Jun;16(3):639-43

1. Not keeping one’s medical knowledge up-to-date (42,6%)

2. Poor doctor-patient relationship (41,2%)

3. Patient age >75 year(41,2%)

4. Language barrier (36,8%)

5. Patient with more than 5 medicaments (33,8%)

6. Patients who ‘shops’ between different GPs (23,5%)

7. No telephonic triage (22,1%)

8. Delayed receipt of information about patients from hospital (17,6%)

Questionnaire risk factors (1)

Patient safety in primary care: a survey of general practitioners in The Netherlands.BMC Health Serv Res. 2010 Jan 21;10:21.

9. Patient who frequently comes for medical unexplained complaints (13,2%)

10.Patient age >70 year (10,3%)

11.Patient with a chronic disease (10,3)

12.Patient who has consulted more than twice during GPs office hours for the same complaint (7,4%)

13.Need to make an emergency visit during regular office hours (7,4%)

14.Deviating from guidelines provided by Dutch College of

General Practitioners (2,9%)

15.Lack of privacy at reception or in waiting room (0%)

Questionnaire risk factors (2)

Patient safety in primary care: a survey of general practitioners in The Netherlands.BMC Health Serv Res. 2010 Jan 21;10:21.

“The electronical medical record of a GP produces a lot of medication interaction warnings. The GP often ignores these without reading the medication warnings carefully.“

Examples

“In a general practice, small surgical procedures which require suturing are done without sterile gloves. “

Examples

“A practice does not discuss errors made in the practice on a regular basis. Errors are resolved on an ad hoc basis by the healthcare workers involved.“

Examples

“A patient is admitted to the hospital with a perforated appendix. Earlier that day, the patient was seen by a GP. The GP gave clear instructions on when the patient should return to see him, and the patient indeed returned to see him..“

Examples

Outline

1. Introduction

2. Aspects of primary care to be targeted (intro: Sander Gaal)

3. Interventions/measures to be developed (intro: Wim Verstappen)

4. Experiences in research funding across countries

RESEARCH WORKSHOP II

Wim VerstappenSander Gaal

Michel Wensing

Possible improvement interventions

Patient safety incidents Determinants (examples) Interventions (examples)

Missed diagnoses Poor access to primary care

Incompetent providers

Inappropriate acceptance of symptoms

Improving telephone triage

Decision support systems

Patient education

Incident reporting

Prospective risk analysis

Treatment risks Incompetent providers

Inadequate patient records

Poor interprofessional communication

Decisions support systems

Pharmacist involvement

Shared patient records

Incident reporting

Prospective risk analysis

Inadequate monitoring of patients Inadequate patient records

Inadequate practice organization

Reminder systems

Restructuring of clinical process

Incident reporting

Prospective risk analysis

Hygiene risks Absence of preventive measures

Vulnerable patients

Use of preventive measures

Active patient involvement

Incident reporting

Prospective risk analysis

Feasibility and effectiveness of improvement strategies for patient

safety in primary care• S. Gaal et al.: What do primary care physicians and researchers

consider the most important patient safety improvement strategies?• BMC Health Services Research 2011 11:102. Purpose: To identify most important strategies. Methods: Web-based survey in an international panel of

58 GPs and GP researchers in countries with a strong primary care system.

• 38 (known and used) strategies were presented. Results: Most strategies were seen as important.• Use of these strategies varied widely.

•

Conclusions

Many different strategies were seen as important.

Highly important strategies with poor implementation were a culture positive for patient safety, education on patient safety and patient safety guidelines.

Educational items ranked high, with low presence scores.

Second websurvey

To identify most important constituents of educational programs to enhance patient safety.

Hygienic procedures, emergency primary care, medication, IT, handover, (telephonic) accessibility.

Methods Developing and experience with educational • practice assessment tool

At the internet practices fill in a questionnaire about 8 most important patient safety themes.

If answering ‘No’ they receive (national)• guidelines automatically.

A pilot in three GP practices in the Netherlands

Results

Assessment of patient safety by webtool

Improvement actions on base of this assessment

Process evaluation of the introduction of webtool

National research programs

• What are experiences in other countries ?

• What can we learn from experiences in research?

• How to enhance research in countries with little research?

• How to to enhance research in countries with more research?

Conclusions …