从患者角度看门诊护理中的患者安全：回顾性、代表性电话调查。
Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey.
机构信息
Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany.
出版信息
BMJ Open. 2020 Feb 16;10(2):e034617. doi: 10.1136/bmjopen-2019-034617.
OBJECTIVES
Data on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany.
DESIGN
Retrospective cross-sectional study.
SETTING
Computer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care.
PARTICIPANTS
10 037 citizens ≥40 years.
MEASURES
A new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs.
RESULTS
1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment.
CONCLUSION
PSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs.
目的
门诊护理中患者安全问题（PSPs）的数据很少。本研究的目的是记录德国门诊护理中 PSP 的频率、类型、严重程度和起源点。
设计
回顾性横断面研究。
设置
在德国，通过计算机辅助电话采访随机招募的≥40 岁公民，询问他们在门诊护理中经历过的 PSP。
参与者
10037 名≥40 岁的公民。
措施
开发了一个新的问卷来记录门诊护理中患者的 PSP 体验。本研究报告的重点是过去 12 个月内患者的体验。该问卷侧重于七个医疗领域的 PSP：病史/诊断程序；药物治疗；疫苗接种、注射、输液；随访；门诊手术；办公室管理；其他领域。对于报告的每一个 PSP，都详细询问了有关专科小组的问题，对于最严重的伤害，还询问了伤害的严重程度及其后果。目标参数以 95%置信区间的比例表示。
结果
1422 名受访者（14%）报告了 2589 起 PSP。受 PSP 影响最严重的领域是病史/诊断程序（61%）和药物治疗（15%）。全科医生占 PSP 的 44%，骨科医生占 15%，内科医生占 10%。75%的 PSP 与伤害有关，尤其是不必要的持续疼痛或健康恶化；35%的 PSP 导致永久性伤害。804 例 PSP（32%）促使患者寻求其他医生进行额外治疗；255 例 PSP（10%）需要住院治疗。
结论
德国门诊护理中患者经历的 PSP 很普遍。该研究揭示了在哪些治疗领域努力预防 PSP 可以为提高患者安全性做出最大贡献。它还证明了患者报告对 PSP 分析的宝贵贡献。
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