Patients’ and consumers’ perceptions of and involvement in safety and quality in Australian general practice

The importance of patient safety and quality research is renowned worldwide, but research outlining the interventions, intended outcomes, measurement and effectiveness are few and far between. Most of the research surrounding patient safety has focused on measurement and identifying what constitutes a risk, analysing, evaluating and managing risks effectively. Identifying practices and process of successful quality improvement can lead to effective results through greater understanding of the development, design and evaluation of complex interventions. Davidoff & Batalden (2005) point out that health care safety and quality research adds to scientific discovery and experiential learning, and that disseminating knowledge leads to better performance.However, there is still lack of relevant, timely, appropriate, accurate and transparent studies on this topic. Research on safety in primary care is just beginning to emerge as much of the literature has focussed on secondary care settings. Furthermore, research involving patients and carers is in its infancy and there has been a call to engage and partner with patients more effectively to improve the safety and quality of care they receive. Patients and carers have an important role to play when preventing errors and reducing harm. They have firsthand experience of their care, and are often able to provide detailed information about the processes, systems and structures that have led to the occurrence of an adverse event. Although there are many well-recognised benefits for involving patients to improve the safety of their care, there are still some unresolved contentions regarding the effectiveness of interventions, the roles and responsibilities for both patients and health professionals, and the kind of health care culture and organisational governance required for patient involvement in safety to occur successfully. A systematic review of the effectiveness of interventions designed to improve the delivery of patient centred care has shown that there are some promising approaches. This mainly includes improving patient education, health literacy, self-management skills, and capacity for making decisions, as well as developing partnerships with physicians, and contributing to safety and quality of care. There is also a growing evidence base centred on how health professionals can better support patient engagement in care. Patient involvement in health care has been proposed as a promising approach to achieving better quality of care, greater cost efficiency, and improved population health. Much of the literature on patient involvement in safety has focussed on partnering with patients to reduce harm in hospital settings. Hand hygiene interventions and speaking up campaigns dominate the evidence base in this area. However, research that has been conducted in general practice is scarce. A tool to measure patient involvement in decision making in general practice has been developed by Elwyn and collegues (2003), Sanders et al (2013) have found that interventions aiming to increase patient participation as a means to improve health outcomes in general practice are non-conclusive, and Flink et al (2012) have investigated patient activation during handover between primary and secondary care. Apart from these studies little else has been undertaken in this setting. To the authors knowledge only one study conducted in Australian general practice found that patient directed questioning improved information provision by physicians and patient involvement in safety. While there are some examples of partnering with patients to improve the safety of primary care, there is no evidence of how patients and carers view safety. Having an in depth understanding of patients and carers perceptions of safety is the starting point for designing and implementing effective and appropriate interventions that can help to reduce harm in the primary care setting.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Biogenic silver nanoparticles eradicate of Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) isolated from the sputum of COVID-19 patients

In recent investigations, secondary bacterial infections were found to be strongly related to mortality in COVID-19 patients. In addition, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) bacteria played an important role in the series of bacterial infections that accompany infection in COVID-19. The objective of the present study was to investigate the ability of biosynthesized silver nanoparticles from strawberries (Fragaria ananassa L.) leaf extract without a chemical catalyst to inhibit Gram-negative P. aeruginosa and Gram-positive Staph aureus isolated from COVID-19 patient’s sputum. A wide range of measurements was performed on the synthesized AgNPs, including UV–vis, SEM, TEM, EDX, DLS, ζ -potential, XRD, and FTIR. UV-Visible spectral showed the absorbance at the wavelength 398 nm with an increase in the color intensity of the mixture after 8 h passed at the time of preparation confirming the high stability of the FA-AgNPs in the dark at room temperature. SEM and TEM measurements confirmed AgNPs with size ranges of ∼40-∼50 nm, whereas the DLS study confirmed their average hydrodynamic size as ∼53 nm. Furthermore, Ag NPs. EDX analysis showed the presence of the following elements: oxygen (40.46%), and silver (59.54%). Biosynthesized FA-AgNPs (ζ = −17.5 ± 3.1 mV) showed concentration-dependent antimicrobial activity for 48 h in both pathogenic strains. MTT tests showed concentration-dependent and line-specific effects of FA-AgNPs on cancer MCF-7 and normal liver WRL-68 cell cultures. According to the results, synthetic FA-AgNPs obtained through an environmentally friendly biological process are inexpensive and may inhibit the growth of bacteria isolated from COVID-19 patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A review of suicide statistics in Australia

This publication is a detailed report on the statistical processes used to track national suicide rates. Suicide is a matter of considerable public interest and policy significance so reliable statistical information on suicide occurrence is important. This report examines in detail the current methodologies used to track suicide rates, identifying issues with the process of suicide reporting and the extent of, and reason for, any under-enumeration of suicide. Revised estimates are provided and the report provides advice for the future statistical monitoring of suicide and self harm in Australia. This report provides a unique insight into the limitations of current data on suicide rates

General practices? perspectives on medicare locals? performance are critical lessons for the success of primary health networks

Background Under a health reform after two decades, Primary Health Organisations (PHOs) in Australia were changed from Divisions of General Practice (DGP) to Medicare Locals (MLs). Following a review of Medicare Locals, in July 2015 Primary Health Networks (PHNs) replaced Medical Locals to potentially improve outcomes through supporting primary care and enhancing integration. Aims The aim of this paper was to gather front-line staff’s perspectives on MLs and identify any lessons applicable to PHNs. Methods A national purposive sample of 22 high-performing general practices representing all Australian states and territories was selected for semi-structured, face-to-face interviews, and a thematic analysis conducted. Results Fifty-three interviews were conducted: participants comprised 19 general practitioners (GPs), 18 practice managers (PMs), 15 practices nurses (PNs), and one community pharmacist. Most participants reflected on the difference between the DGP and MLs. Themes that emerged included ambiguity, community needs, professional development and education, communication and support, duplication in services and ignoring existing ones, recruitment and retention, and engagement and involvement. Conclusion Those MLs that did well continued in an expanded way the work DGP were doing beforehand and made a seamless transition. PHNs will need to build on the strengths of previous PHOs, and create locality structures and processes that maximise the potential for clinical engagement. They will actively guide the dialogue between related microsystems: to achieve this they will have to be clinically led, change management organisations

Primary Health Networks: Lessons for Success

Background Under a health reform after two decades, Primary Health Organisations (PHOs) in Australia were changed from Divisions of General Practice (DGP) to Medicare Locals (MLs). Following a review of Medicare Locals, in July 2015 Primary Health Networks (PHNs) replaced Medical Locals to potentially improve outcomes through supporting primary care and enhancing integration. Aims The aim of this paper was to gather front-line staff’s perspectives on MLs and identify any lessons applicable to PHNs. Methods A national purposive sample of 22 high-performing general practices representing all Australian states and territories was selected for semi-structured, face-to-face interviews, and a thematic analysis conducted. Results Fifty-three interviews were conducted: comprised 19 general practitioners (GPs), 18 practice managers (PMs), 15 practices nurses (PNs), and one community pharmacist. Most participants reflected on the difference between the DGP and MLs. Themes that emerged included ambiguity, community needs, professional development and education, communication and support, duplication in services and ignoring existing ones, recruitment and retention, and engagement and involvement. Conclusion Those MLs that did well continued in an expanded way the work DGP were doing beforehand and made a seamless transition. PHNs will need to build on the strengths of previous PHOs, and create locality structures and processes that maximise the potential for clinical engagement. They will actively guide the dialogue between related microsystems: to achieve this they will have to be clinically led, change management organisations