Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care.

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients

Développement d’un document d’éducation des patients pour la déprescription des inhibiteurs de la pompe à protons : une étude par méthode mixte

International audienc

Differential item functioning in the French revised Patients’ Attitudes Toward Deprescribing questionnaire: a case analysis from the DeprescrIPP trial

International audienceBackground: Patient-reported outcome measures (PROMs) are commonly used in deprescribing studies. Assuming measurement invariance, patients with different characteristics should perceive and interpret the items in the same way. However, differential item functioning (DIF) may occur when patients from two different subgroups perceive or interpret an item differently in PROMs. These patients with a same ”true” level have differential probabilities of endorsing an item. If DIF occurs, the estimation of the difference when comparing two subgroups may be biased.Objective: This study aims to detect DIF in the revised Patients’ Attitudes Toward Deprescribing questionnaire (rPATD).Methods: Data from a proton pump inhibitors (PPI) deprescribing trial in France were used. The French rPATD was sent by post to a 10% sample of patients who received PPI for more than one year, before the start of the trial in November 2020. Firstly, we will verify that our data fits a partial credit model, i.e. unidimensionality and local independence. Secondly, we will assess the DIF across three covariables: gender, age, and medication management. The DIF detection will be performed at the item-level using the ROSALI algorithm, previously described and developed on STATA.Results: A total of 1862 patients responded to the rPATD. The analyses are currently performed.Conclusions: At the conference, we will be able to i) assess the occurrence of DIF in our dataset and ii) illustrate how to detect DIF in PROMs to avoid measurement bias

Attitudes towards deprescribing among proton pomp inhibitors chronic users

International audienceBackground: Deprescribing proton pump inhibitors (PPI) is recommended when itsuse is considered inappropriate. Patients' beliefs and perceptions of deprescribing shouldbe explored to target patients who are potentially willing to reduce or stop their PPI use.Objective: The objective of this study was to assess the attitudes toward deprescribingamong PPI chronic users in the French setting.Methods: This is an ancillary study of a pragmatic trial conducted on adults having over300 defined daily doses of PPI dispensed in the year before inclusion. One month beforethe start of this trial, we mailed the French version of the revised Patients’ AttitudeToward Deprescribing questionnaire (rPATD) to a 10% sample. We used descriptiveanalysis to depict the characteristics of the respondents. We used multivariate analysis toexplore associations between characteristics and answers to the rPATD.Results: A total of 1861 questionnaires were collected among 3554 targeted patients(52.4% response-rate). The mean age was 76.6 years (SD 7.8), 55% were female, 63%had at least one chronic condition. Among the responders, 75% reported being satisfiedwith their current medicines although 91% reported that they would be willing to stop atleast one of their current medications if their doctor said it was possible. Answersresulted in a high involvement factor score (mean = 4.4; SD 0.9) and a lowappropriateness factor score (mean = 1.9; SD 1.1). Male sex (p = .016) and having adoctor working in a group practice (p = .010) were the characteristics significantlyassociated with a willingness to deprescribe at least one medication.Conclusion: Most PPI chronic users are willing to deprescribe at least one of theircurrent medications. These findings and upcoming results of our deprescribing trialshould address whether the rPATD can predict the success of a deprescribingintervention

Questionnaire "Attitude des patients envers la déprescription" dans un essai de déprescription des inhibiteurs de la pompe à protons : propriétés psychométriques

International audienc

Attitudes towards deprescribing among proton pomp inhibitors chronic users

International audienceBackground: Deprescribing proton pump inhibitors (PPI) is recommended when itsuse is considered inappropriate. Patients' beliefs and perceptions of deprescribing shouldbe explored to target patients who are potentially willing to reduce or stop their PPI use.Objective: The objective of this study was to assess the attitudes toward deprescribingamong PPI chronic users in the French setting.Methods: This is an ancillary study of a pragmatic trial conducted on adults having over300 defined daily doses of PPI dispensed in the year before inclusion. One month beforethe start of this trial, we mailed the French version of the revised Patients’ AttitudeToward Deprescribing questionnaire (rPATD) to a 10% sample. We used descriptiveanalysis to depict the characteristics of the respondents. We used multivariate analysis toexplore associations between characteristics and answers to the rPATD.Results: A total of 1861 questionnaires were collected among 3554 targeted patients(52.4% response-rate). The mean age was 76.6 years (SD 7.8), 55% were female, 63%had at least one chronic condition. Among the responders, 75% reported being satisfiedwith their current medicines although 91% reported that they would be willing to stop atleast one of their current medications if their doctor said it was possible. Answersresulted in a high involvement factor score (mean = 4.4; SD 0.9) and a lowappropriateness factor score (mean = 1.9; SD 1.1). Male sex (p = .016) and having adoctor working in a group practice (p = .010) were the characteristics significantlyassociated with a willingness to deprescribe at least one medication.Conclusion: Most PPI chronic users are willing to deprescribe at least one of theircurrent medications. These findings and upcoming results of our deprescribing trialshould address whether the rPATD can predict the success of a deprescribingintervention

Suitability of patient education materials on proton-pump inhibitors deprescribing: a focused review

International audiencePurposeEngaging patients in the process of deprescribing is a necessity. Several patient education materials have been developed for this purpose. The aim of this study was to assess the suitability of the existing patient education materials for proton-pump inhibitors deprescribing.MethodsWe conducted a targeted inventory of the available materials on scientific literature and known repositories. We evaluated their suitability with the Suitability Assessment of Materials (SAM) instrument. Materials were rated independently by two researchers and then discussed until consensus was reached.ResultsSeven patient education materials were identified. Three materials (42.9%) were deemed “superior” and 4 (57.1%) were deemed “adequate”. Ratings were generally good in the categories of content, learning stimulation, motivation, typography and layout. The major weaknesses included the use of inappropriate graphics and the too demanding required reading grade level. These may decrease patient attention and comprehension and therefore the effectiveness of education materials.ConclusionsSuitability of the patient education materials on proton-pump inhibitors deprescribing is overall satisfactory. Greater attention on readability, graphics and inclusion of summaries will be needed for development of future materials

Development and validation of search filters to retrieve medication discontinuation articles in Medline and Embase

International audienceAbstract Background Medication discontinuation studies explore the outcomes of stopping a medication compared to continuing it. Comprehensively identifying medication discontinuation articles in bibliographic databases remains challenging due to variability in terminology. Objectives To develop and validate search filters to retrieve medication discontinuation articles in Medline and Embase. Methods We identified medication discontinuation articles in a convenience sample of systematic reviews. We used primary articles to create two reference sets for Medline and Embase, respectively. The reference sets were equally divided by randomization in development sets and validation sets. Terms relevant for discontinuation were identified by term frequency analysis in development sets and combined to develop two search filters that maximized relative recalls. The filters were validated against validation sets. Relative recalls were calculated with their 95% confidences intervals (95% CI). Results We included 316 articles for Medline and 407 articles for Embase, from 15 systematic reviews. The Medline optimized search filter combined 7 terms. The Embase optimized search filter combined 8 terms. The relative recalls were respectively 92% (95% CI: 87–96) and 91% (95% CI: 86–94). Conclusions We developed two search filters for retrieving medication discontinuation articles in Medline and Embase. Further research is needed to estimate precision and specificity of the filters

Development and validation of search filters to identify articles on deprescribing in Medline and Embase

International audienceBackground: Deprescribing literature has been increasing rapidly. Our aim was to develop and validate search filters to identify articles on deprescribing in Medline via PubMed and in Embase via Embase. com. Methods: Articles published from 2011 to 2020 in a core set of eight journals (covering fields of interest for deprescribing, such as geriatrics, pharmacology and primary care) formed a reference set. Each article was screened independently in duplicate and classified as relevant or non-relevant to deprescribing. Relevant terms were identified by term frequency analysis in a 70% subset of the reference set. Selected title and abstract terms, MeSH terms and Emtree terms were combined to develop two highly sensitive filters for Medline via Pubmed and Embase via Embase. com. The filters were validated against the remaining 30% of the reference set. Sensitivity, specificity and precision were calculated with their 95% confidence intervals (95% CI). Results: A total of 23,741 articles were aggregated in the reference set, and 224 were classified as relevant to deprescribing. A total of 34 terms and 4 MeSH terms were identified to develop the Medline search filter. A total of 27 terms and 6 Emtree terms were identified to develop the Embase search filter. The sensitivity was 92% (95% CI: 83-97%) in Medline via Pubmed and 91% (95% CI: 82-96%) in Embase via Embase. com. Conclusions: These are the first deprescribing search filters that have been developed objectively and validated. These filters can be used in search strategies for future deprescribing reviews. Further prospective studies are needed to assess their effectiveness and efficiency when used in systematic reviews

Does missing data matter in the revised Patients' Attitude Towards Deprescribing questionnaire? A systematic review and two case analyses

International audienc