Patient safety culture measurement in general practice. Clinimetric properties of 'SCOPE'

<p>Abstract</p> <p>Background</p> <p>A supportive patient safety culture is considered to be an essential condition for improving patient safety. Assessing the current safety culture in general practice may be a first step to target improvements. To that end, we studied internal consistency and construct validity of a safety culture questionnaire for general practice (SCOPE) which was derived from a comparable questionnaire for hospitals (Dutch-HSOPS).</p> <p>Methods</p> <p>The survey was conducted among caregivers of Dutch general practice as part of an ongoing quality accreditation process using a 46 item questionnaire. We conducted factor analyses and studied validity by calculating correlations between the subscales and testing the hypothesis that respondents' <it>patient safety grade </it>of their practices correlated with their scores on the questionnaire.</p> <p>Results</p> <p>Of 72 practices 294 respondents completed the questionnaire. Eight factors were identified concerning <it>handover and teamwork, support and fellowship, communication openness, feedback and learning from error, intention to report events, adequate procedures and staffing, overall perceptions of patient safety </it>and <it>expectations and actions of managers</it>. Cronbach's alpha of the factors rated between 0.64 and 0.85. The subscales intercorrelated moderately, except for the factor about intention to report events. Respondents who graded patient safety highly scored significantly higher on the questionnaire than those who did not.</p> <p>Conclusions</p> <p>The SCOPE questionnaire seems an appropriate instrument to assess patient safety culture in general practice. The clinimetric properties of the SCOPE are promising, but future research should confirm the factor structure and construct of the SCOPE and delineate its responsiveness to changes in safety culture over time.</p

Patient safety in Dutch primary care: a study protocol

<p>Abstract</p> <p>Background</p> <p>Insight into the frequency and seriousness of potentially unsafe situations may be the first step towards improving patient safety. Most patient safety attention has been paid to patient safety in hospitals. However, in many countries, patients receive most of their healthcare in primary care settings. There is little concrete information about patient safety in primary care in the Netherlands. The overall aim of this study was to provide insight into the current patient safety issues in Dutch general practices, out-of-hours primary care centres, general dental practices, midwifery practices, and allied healthcare practices. The objectives of this study are: to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients; to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals; and to provide insight into patient safety management in primary care practices.</p> <p>Design and methods</p> <p>The study consists of three parts: a retrospective patient record study of 1,000 records per practice type was conducted to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients (objective one); a prospective component concerns an incident-reporting study in each of the participating practices, during two successive weeks, to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals (objective two); to provide insight into patient safety management in Dutch primary care practices (objective three), we surveyed organizational and cultural items relating to patient safety. We analysed the incidents found in the retrospective patient record study and the prospective incident-reporting study by type of incident, causes (Eindhoven Classification Model), actual harm (severity-of-outcome domain of the International Taxonomy of Medical Errors in Primary Care), and probability of severe harm or death.</p> <p>Discussion</p> <p>To estimate the frequency of incidents was difficult. Much depended on the accuracy of the patient records and the professionals' consensus about which types of adverse events have to be recognized as incidents.</p

Oral and pharyngeal cancer:Analysis of patient delay at different tumor stages

Background. The aim of this study was to examine which factors are related to patient delay in a cohort of consecutive patients with pharyngeal cancer and oral cancer and to determine whether the different stages of patient delay (ie, appraisal, illness, behavioral, and scheduling) were related to different tumor stages. Methods. Before treatment, 55 patients with pharyngeal cancer and 134 patients with oral cancer were interviewed about their prediagnostic period. To verify the data, a questionnaire was sent to the general practitioner and/or dentist and a close relative, Results. Patients with a delay of more than 30 days were significantly more often diagnosed with late-stage (T3-T4) disease (pharynx, p = .01, odds ratio [OR] = 4.5; oral, p =.01, OR = 3.2). No sociodemographic characteristics were associated with patient delay. Conclusions. Prolonged patient delay was associated with late-stage disease for both patients with pharyngeal cancer and patients with oral cancer. Although for most patients the symptoms are vague or might look like a common cold or infection, the general public should be better informed about tumor symptoms. This may enhance earlier visits to a health care professional. (c) 2005 Wiley Periodicals, Inc

What do primary care physicians and researchers consider the most important patient safety improvement strategies?

Contains fulltext : 96521.pdf (postprint version ) (Open Access)BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by consulting an international panel of primary care physicians and researchers. METHODS: A web-based survey was undertaken in an international panel of 58 individuals from eight countries with a strong primary care system. The questionnaire consisted of 38 strategies to improve patient safety. We asked the respondents whether these strategies were currently used in their own country, and whether they felt them to be important. RESULTS: Most of the 38 presented strategies were seen as important by a majority of the participants, but the use of strategies in daily practice varied widely. Strategies that yielded the highest scores (>70%) regarding importance included a good medical record system (82% felt this was very important, while 83% said it was implemented in more than half of the practices), good telephone access (71% importance, 83% implementation), standards for record keeping (75% importance, 62% implementation), learning culture (74% importance, 10% implementation), vocational training on patient safety for GPs (81% importance, 24% implementation) and the presence of a patient safety guideline (81% importance, 15% implementation). CONCLUSION: An international panel of primary care physicians and researchers felt that many different strategies to improve patient safety were important. Highly important strategies with poor implementation included a culture that is positive for patient safety, education on patient safety for physicians, and the presence of a patient safety guideline

Executive summary Avian flu epidemic 2003: public health consequences

Hoofdrapport: RIVM rapport 630940001Bijlagen: RIVM rapport 630940002Beleidssamenvatting Vogelpest Epidemie 2003: gevolgen voor de volksgezondheid.Risicofactoren, gezondheid, welbevinden, zorgbehoefte en preventieve maatregelen tijdens de bestrijding van Aviaire Influenza H7N7 in Nederland.Naar schatting minimaal duizend mensen zijn tijdens de vogelpest epidemie in 2003 besmet met het vogelpest virus. Eenderde van de pluimveehouders met een geruimd bedrijf meldde stressreacties, vermoeidheid en depressieve klachten. De grootschalige verspreiding onderstreept het belang van maatregelen tegen overdracht van het vogelpestvirus van pluimvee naar de mens bij contact met besmet pluimvee. De mogelijke onzekerheid, stress en spanningsklachten samenhangend met de bestrijding van de vogelpest epidemie vereisen specifieke zorg.Er meldden zich 453 personen met gezondheidsklachten, voornamelijk oogvliesontsteking. Antistoffen werden ook aangetroffen bij 59% van huisgenoten van bestrijders die een infectie met vogelpestvirus doormaakten. Circa 50% van de 500 onderzochte personen die tijdens de epidemie contact hadden met besmet pluimvee had antistoffen tegen vogelpestvirus.Pluimveehouders en bestrijders leefden de preventieve maatregelen slecht na. Het antivirale middel oseltamivir bleek te beschermen tegen besmetting, mond-neus maskers niet. De aandacht voor de begeleiding van pluimveehouders en andere betrokkenen en voor de informatie over en de bejegening tijdens de ruimingen hebben behoorlijk gewerkt. Extern ingehuurde dierenartsen ervoeren hun werkzaamheden vaker als emotioneel belastend dan andere betrokken beroepsgroepen.Circa een kwart van de pluimveehouders met geruimde bedrijven heeft zorgen om het voortbestaan van het bedrijf en de sector, 16% had behoefte aan aanvullende ondersteuning, hulp of zorg vanwege de vogelpest. Daarvoor benaderden zij de agro-hulpverlening en de huisarts, en minder vaak de geestelijke gezondheidszorg.Executive summary Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.An estimated thousand people, possibly more have been infected with avian flu during the outbreak in the Netherlands in 2003. One third of the poultry farmers whose holdings were cleared reported stress reactions, fatigue and depressive symptoms. The large spread of the virus underscores the importance of the measures to prevent poultry-to-human transmission in people handling infected poultry. The possible uncertainty, stress and anxiety associated with the avian flu control demand specific health care attention. A total of 453 people reported with health complaints, predominantly conjunctivitis. Antibodies were found in 59% of infected poultry workers' family members. Of the 500 tested persons who had handled infected poultry, about 50% showed an antibody response. The poultry farmers and workers complied insufficiently with the preventive measures. The antiviral drug oseltamivir protected against infection, whereas mouth and nose masks did not. The attention for support, information and respectful treatment of poultry farmers and workers during the clearances worked quite well. Externally hired veterinarians experienced their activities as emotionally aggravating more often than other professionals. About a quarter of the poultry farmers worried about the survival of their holding and the sector as a whole; 16% felt a need for additional support, help or health care because of the avian flu. They consulted agricultural care providers and family doctors, and less frequently mental health care providers.VW

Beleidssamenvatting Vogelpest Epidemie 2003: Gevolgen voor de volksgezondheid

Executive summary Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.An estimated thousand people, possibly more have been infected with avian flu during the outbreak in the Netherlands in 2003. One third of the poultry farmers whose holdings were cleared reported stress reactions, fatigue and depressive symptoms. The large spread of the virus underscores the importance of the measures to prevent poultry-to-human transmission in people handling infected poultry. The possible uncertainty, stress and anxiety associated with the avian flu control demand specific health care attention. A total of 453 people reported with health complaints, predominantly conjunctivitis. Antibodies were found in 59% of infected poultry workers' family members. Of the 500 tested persons who had handled infected poultry, about 50% showed an antibody response. The poultry farmers and workers complied insufficiently with the preventive measures. The antiviral drug oseltamivir protected against infection, whereas mouth and nose masks did not. The attention for support, information and respectful treatment of poultry farmers and workers during the clearances worked quite well. Externally hired veterinarians experienced their activities as emotionally aggravating more often than other professionals. About a quarter of the poultry farmers worried about the survival of their holding and the sector as a whole; 16% felt a need for additional support, help or health care because of the avian flu. They consulted agricultural care providers and family doctors, and less frequently mental health care providers.Beleidssamenvatting Vogelpest Epidemie 2003: gevolgen voor de volksgezondheid.Risicofactoren, gezondheid, welbevinden, zorgbehoefte en preventieve maatregelen tijdens de bestrijding van Aviaire Influenza H7N7 in Nederland.Naar schatting minimaal duizend mensen zijn tijdens de vogelpest epidemie in 2003 besmet met het vogelpest virus. Eenderde van de pluimveehouders met een geruimd bedrijf meldde stressreacties, vermoeidheid en depressieve klachten. De grootschalige verspreiding onderstreept het belang van maatregelen tegen overdracht van het vogelpestvirus van pluimvee naar de mens bij contact met besmet pluimvee. De mogelijke onzekerheid, stress en spanningsklachten samenhangend met de bestrijding van de vogelpest epidemie vereisen specifieke zorg.Er meldden zich 453 personen met gezondheidsklachten, voornamelijk oogvliesontsteking. Antistoffen werden ook aangetroffen bij 59% van huisgenoten van bestrijders die een infectie met vogelpestvirus doormaakten. Circa 50% van de 500 onderzochte personen die tijdens de epidemie contact hadden met besmet pluimvee had antistoffen tegen vogelpestvirus.Pluimveehouders en bestrijders leefden de preventieve maatregelen slecht na. Het antivirale middel oseltamivir bleek te beschermen tegen besmetting, mond-neus maskers niet. De aandacht voor de begeleiding van pluimveehouders en andere betrokkenen en voor de informatie over en de bejegening tijdens de ruimingen hebben behoorlijk gewerkt. Extern ingehuurde dierenartsen ervoeren hun werkzaamheden vaker als emotioneel belastend dan andere betrokken beroepsgroepen.Circa een kwart van de pluimveehouders met geruimde bedrijven heeft zorgen om het voortbestaan van het bedrijf en de sector, 16% had behoefte aan aanvullende ondersteuning, hulp of zorg vanwege de vogelpest. Daarvoor benaderden zij de agro-hulpverlening en de huisarts, en minder vaak de geestelijke gezondheidszorg

Avian flu epidemic 2003: public health consequences

Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.An estimated thousand people, possibly more have been infected with avian flu during the outbreak in the Netherlands in 2003. One third of the poultry farmers whose holdings were cleared reported stress reactions, fatigue and depressive symptoms. The large spread of the virus underscores the importance of the measures to prevent poultry-to-human transmission in people handling infected poultry. The possible uncertainty, stress and anxiety associated with the avian flu control demand specific health care attention. A total of 453 people reported with health complaints, predominantly conjunctivitis. Antibodies were found in 59% of infected poultry workers' family members. Of the 500 tested persons who had handled infected poultry, about 50% showed an antibody response. The poultry farmers and workers complied insufficiently with the preventive measures. The antiviral drug oseltamivir protected against infection, whereas mouth and nose masks did not. The attention for support, information and respectful treatment of poultry farmers and workers during the clearances worked quite well. Externally hired veterinarians experienced their activities as emotionally aggravating more often than other professionals. About a quarter of the poultry farmers worried about the survival of their holding and the sector as a whole; 16% felt a need for additional support, help or health care because of the avian flu. They consulted agricultural care providers and family doctors, and less frequently mental health care providers.Vogelpest Epidemie 2003: gevolgen voor de volksgezondheid.Risicofactoren, gezondheid, welbevinden, zorgbehoefte en preventieve maatregelen tijdens de bestrijding van Aviaire Influenza H7N7 in Nederland.Naar schatting minimaal duizend mensen zijn tijdens de vogelpest epidemie in 2003 besmet met het vogelpest virus. Eenderde van de pluimveehouders met een geruimd bedrijf meldde stressreacties, vermoeidheid en depressieve klachten. De grootschalige verspreiding onderstreept het belang van maatregelen tegen overdracht van het vogelpestvirus van pluimvee naar de mens bij contact met besmet pluimvee. De mogelijke onzekerheid, stress en spanningsklachten samenhangend met de bestrijding van de vogelpest epidemie vereisen specifieke zorg.Er meldden zich 453 personen met gezondheidsklachten, voornamelijk oogvliesontsteking. Antistoffen werden ook aangetroffen bij 59% van huisgenoten van bestrijders die een infectie met vogelpestvirus doormaakten. Circa 50% van de 500 onderzochte personen die tijdens de epidemie contact hadden met besmet pluimvee had antistoffen tegen vogelpestvirus.Pluimveehouders en bestrijders leefden de preventieve maatregelen slecht na. Het antivirale middel oseltamivir bleek te beschermen tegen besmetting, mond-neus maskers niet. De aandacht voor de begeleiding van pluimveehouders en andere betrokkenen en voor de informatie over en de bejegening tijdens de ruimingen hebben behoorlijk gewerkt. Extern ingehuurde dierenartsen ervoeren hun werkzaamheden vaker als emotioneel belastend dan andere betrokken beroepsgroepen.Circa een kwart van de pluimveehouders met geruimde bedrijven heeft zorgen om het voortbestaan van het bedrijf en de sector, 16% had behoefte aan aanvullende ondersteuning, hulp of zorg vanwege de vogelpest. Daarvoor benaderden zij de agro-hulpverlening en de huisarts, en minder vaak de geestelijke gezondheidszorg

Appendices to: Avian flu epidemic 2003: public health consequences

Appendices to: Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.Bijlagen bij:Vogelpest Epidemie 2003: gevolgen voor de volksgezondheid.Risicofactoren, gezondheid, welbevinden, zorgbehoefte en preventieve maatregelen tijdens de bestrijding van Aviaire Influenza H7N7 in Nederlan