Future research directions for patient safety in primary care

1. Future research directions for patient safety in primary care Michel Wensing Wim Verstappen Sander Gaal

2. Aims of this workshop • To provide ideas and inspiration for research on patient safety in primary care • To identify shared interests and explore opportunities for collaboration • To inform the research agenda in the field and guide research funders

3. Introduction Aspects of primary care to be targeted (intro: Sander Gaal) Interventions/measures to be developed (intro: Wim Verstappen) Experiences in research funding across countries Outline

4. Structure of group work • Clarification and individualcompletion of questionnaire (10 min) • Moderated discussion in group (40-60 min) • Add/change responses to questionnaires individually (10 min) • Provide complete questionnaire (1 min) • Plenarydiscussion (not feedback from all groups) (10-30 min) • Creategroups • Session 1: 9.10 – 10.40 hours • Session 2: 11.00-12.30 hours

5. Introduction Aspects of primary care to be targeted (intro: Sander Gaal) Interventions/measures to be developed (intro: Wim Verstappen) Experiences in research funding across countries Outline

6. 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 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

7. Not keeping one’s medical knowledge up-to-date (42,6%) Poor doctor-patient relationship (41,2%) Patient age >75 year(41,2%) Language barrier (36,8%) Patient with more than 5 medicaments (33,8%) Patients who ‘shops’ between different GPs (23,5%) No telephonic triage (22,1%) 8. Delayed receipt of information about patients from hospital (17,6%) Patient safety in primary care: a survey of general practitioners in The Netherlands. BMC Health Serv Res. 2010 Jan 21;10:21.

8. Patient who frequently comes for medical unexplained complaints (13,2%) Patient age >70 year (10,3%) Patient with a chronic disease (10,3) Patient who has consulted more than twice during GPs office hours for the same complaint (7,4%) 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%) Patient safety in primary care: a survey of general practitioners in The Netherlands. BMC Health Serv Res. 2010 Jan 21;10:21.

9. Examples “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.“

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

11. 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.“

12. 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..“

13. Introduction Aspects of primary care to be targeted (intro: Sander Gaal) Interventions/measures to be developed (intro: Wim Verstappen) Experiences in research funding across countries Outline

14. RESEARCH WORKSHOP II Wim Verstappen Sander Gaal Michel Wensing

15. Possible improvement interventions

16. 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.

17. 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.

18. Second websurvey • To identify most important constituents of educational programs to enhance patient safety. • Hygienic procedures, emergency primary care, medication, IT, handover, (telephonic) accessibility.

19. 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

20. Results • Assessment of patient safety by webtool • Improvement actions on base of this assessment • Process evaluation of the introduction of webtool

21. National research programs • What are experiences in othercountries ? • Whatcan we learnfromexperiences in research? • How to enhance research in countrieswithlittle research? • How to toenhance research in countrieswith more research?

22. Conclusions …