Ricci-Cabello Ignacio, Marsden Kate S, Avery Anthony J, Bell Brian G, Kadam Umesh T, Reeves David, Slight Sarah P, Perryman Katherine, Barnett Jane, Litchfield Ian, Thomas Sally, Campbell Stephen M, Doos Lucy, Esmail Aneez, Valderas Jose M
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
School of Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK.
Br J Gen Pract. 2017 Jul;67(660):e474-e482. doi: 10.3399/bjgp17X691085. Epub 2017 Jun 5.
Description of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients.
To examine patient-reported experiences and outcomes of patient safety in primary care.
Cross-sectional study in 45 general practices across five regions in the north, centre, and south of England.
A version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included 'practice activation' (what a practice does to create a safe environment); 'patient activation' (how proactive are patients in ensuring safe healthcare delivery); 'experiences of safety events' (safety errors); 'outcomes of safety' (harm); and 'overall perception of safety' (how safe patients rate their practice).
Questionnaires were returned by 1244 patients (18.4%). Scores were high for 'practice activation' (mean [standard error] = 80.4 out of 100 [2.0]) and low for 'patient activation' (26.3 out of 100 [2.6]). Of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]).
Priority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation.
以往关于全科医疗中安全问题和伤害的描述主要依赖于医疗专业人员提供的信息，而很少关注患者的经历。
研究患者报告的初级医疗中患者安全的经历和结果。
对英格兰北部、中部和南部五个地区的45家全科诊所进行横断面研究。
向6736名患者的随机样本发送了一份初级医疗中患者报告的安全经历和结果（PREOS-PC）问卷。主要结局指标包括“诊所激活”（诊所为创造安全环境所采取的措施）；“患者激活”（患者在确保安全医疗服务提供方面的积极程度）；“安全事件经历”（安全失误）；“安全结果”（伤害）；以及“对安全的总体感知”（患者对其诊所安全程度的评价）。
1244名患者（18.4%）返回了问卷。“诊所激活”得分较高（平均[标准误]=100分中的80.4分[2.0]），“患者激活”得分较低（100分中的26.3分[2.6]）。在这些患者中，45%报告在过去12个月中至少经历过一次安全问题，主要与预约（33%）、诊断（17%）、医患沟通（15%）以及医疗服务提供者之间的协调（14%）有关。23%的应答者报告在过去12个月中受到了某种程度的伤害。对诊所安全水平的总体评估普遍较高（100分中的86.0分[16.8]）。
英格兰全科医疗中改善患者安全的优先领域包括预约、诊断、沟通、协调和患者激活。
