初级保健中的患者安全：荷兰全科医生调查。
Patient safety in primary care: a survey of general practitioners in The Netherlands.
机构信息
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands.
出版信息
BMC Health Serv Res. 2010 Jan 21;10:21. doi: 10.1186/1472-6963-10-21.
BACKGROUND
Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be equally broad. Previous research on safety in primary care has focused on medication safety and incident reporting. In this study, the views of general practitioners (GPs) on patient safety were examined.
METHODS
A web-based survey of a sample of GPs was undertaken. The items were derived from aspects of patient safety issues identified in a prior interview study. The questionnaire used 10 clinical cases and 15 potential risk factors to explore GPs' views on patient safety.
RESULTS
A total of 68 GPs responded (51.5% response rate). None of the clinical cases was uniformly judged as particularly safe or unsafe by the GPs. Cases judged to be unsafe by a majority of the GPs concerned either the maintenance of medical records or prescription and monitoring of medication. Cases which only a few GPs judged as unsafe concerned hygiene, the diagnostic process, prevention and communication. The risk factors most frequently judged to constitute a threat to patient safety were a poor doctor-patient relationship, insufficient continuing education on the part of the GP and a patient age over 75 years. Language barriers and polypharmacy also scored high. Deviation from evidence-based guidelines and patient privacy in the reception/waiting room were not perceived as risk factors by most of the GPs.
CONCLUSION
The views of GPs on safety and risk in primary care did not completely match those presented in published papers and policy documents. The GPs in the present study judged a broader range of factors than in previously published research on patient safety in primary care, including a poor doctor-patient relationship, to pose a potential threat to patient safety. Other risk factors such as infection prevention, deviation from guidelines and incident reporting were judged to be less relevant than by policy makers.
背景
初级保健涵盖了许多不同的临床领域和患者群体，这意味着初级保健中的患者安全可能同样广泛。先前关于初级保健安全的研究侧重于药物安全和事件报告。在这项研究中，考察了全科医生（GP）对患者安全的看法。
方法
对一组 GP 进行了基于网络的调查。这些项目源自先前访谈研究中确定的患者安全问题的各个方面。问卷使用了 10 个临床病例和 15 个潜在风险因素来探讨 GP 对患者安全的看法。
结果
共有 68 名 GP 做出回应（51.5%的回应率）。没有一个临床病例被大多数 GP 一致判断为特别安全或不安全。大多数 GP 认为不安全的病例涉及医疗记录的维护或处方和药物监测。只有少数 GP 认为不安全的病例涉及卫生、诊断过程、预防和沟通。被认为对患者安全构成威胁的风险因素是医患关系不佳、GP 继续教育不足以及患者年龄超过 75 岁。语言障碍和多种药物治疗也得分很高。大多数 GP 认为偏离循证指南和在接待/候诊室中的患者隐私不是风险因素。
结论
GP 对初级保健中安全和风险的看法与已发表的论文和政策文件中提出的观点不完全一致。本研究中的 GP 对安全和风险的看法比之前发表的关于初级保健中患者安全的研究更广泛，包括医患关系不佳等潜在威胁患者安全的因素。其他风险因素，如感染预防、偏离指南和事件报告，被政策制定者认为不如其他因素重要。
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