Active outreach to vulnerable patients during COVID-19 : a common practice or exception in primary health care?

Introduction: The COVID-19 pandemic led directly and indirectly to an increased number of vulnerable population groups. General practitioners (GPs) were in the best position to identify vulnerable patients and limit the growth of health inequities. However, COVID-19 confronted GP practices with unprecedented structural and organizational challenges to provide high-quality care. Did GPs in Europe succeed in setting up outreach activities for maintaining their key role? Method: We used data from the PRICOV-19 study among GP practices in 38 European countries for the analyses. A scale on active outreach was constructed based on six items as the outcome variable. Using the software MLWin, multilevel Poisson analyses were performed on GP practices nested in countries. Results: The results showed a reliable 6-item scale on active outreach with an internal consistency coefficient of 0.69 (Cronbach alpha). According to preliminary analysis (using 2nd order PQL estimation) on 3,928 GP practices, the following practice characteristics were significantly negatively associated with the setup of outreach activities: monodisciplinarity (versus multidisciplinarity) and being a solo or duo GP practice (versus being a group practice). In addition, outreach activities were significantly more common in GP practices with above-average patients with chronic disorders. Conclusions: Further analyses are needed to verify and elaborate the current statements

Patient safety incidents are common in primary care: A national prospective active incident reporting survey

<div><p>Background</p><p>The study objectives were to describe the incidence and the nature of patient safety incidents (PSIs) in primary care general practice settings, and to explore the association between these incidents and practice or organizational characteristics.</p><p>Methods</p><p>GPs, randomly selected from a national influenza surveillance network (n = 800) across France, prospectively reported any incidents observed each day over a one-week period between May and July 2013. An incident was an event or circumstance that could have resulted, or did result, in harm to a patient, which the GP would not wish to recur. Primary outcome was the incidence of PSIs which was determined by counting reports per total number of patient encounters. Reports were categorized using existing taxonomies. The association with practice and organizational characteristics was calculated using a negative binomial regression model.</p><p>Results</p><p>127 GPs (participation rate 79%) reported 317 incidents of which 270 were deemed to be a posteriori judged preventable, among 12,348 encounters. 77% had no consequences for the patient. The incidence of reported PSIs was 26 per 1000 patient encounters per week (95% CI [23‰ -28‰]). Incidents were three times more frequently related to the organization of healthcare than to knowledge and skills of health professionals, and especially to the workflow in the GPs’ offices and to the communication between providers and with patients. Among GP characteristics, three were related with an increased incidence in the final multivariable model: length of consultation higher than 15 minutes, method of receiving radiological results (by fax compared to paper or email), and being in a multidisciplinary clinic compared with sole practitioners.</p><p>Conclusions</p><p>Patient safety incidents (PSIs) occurred in mean once every two days in the sampled GPs and 2% of them were associated with a definite possibility for harm. Studying the association between organizational features of general practices and PSIs remains a major challenge and one of the most important issues for safety in primary care.</p></div

Flowchart of GPs recruitment.

<p>Flowchart of GPs recruitment.</p

Estimate of relative risks (final model).

<p>Estimate of relative risks (final model).</p

Univariate analysis of association between organizational characteristics of GP offices and frequency of incidents.

<p>Univariate analysis of association between organizational characteristics of GP offices and frequency of incidents.</p

Incidence for 1 000 patient encounters by type of encounter.

<p>Incidence for 1 000 patient encounters by type of encounter.</p

Incidence for 1 000 encounters according to the tempo method.

<p>Incidence for 1 000 encounters according to the tempo method.</p