Wednesday, September 29, 2010

Patient Safety 2010 Eurobarometer

The supplement on Patient Safety, of the newsletter of the National Health System’s Quality Agency, announces the publication of the Patient Safety 2010 Eurobarometer.

It is a very complete report, with 107 pages, containing the results of 26,663 questionnaires in the 27 EU countries.

Nosocomial infections are the adverse effects perceived as most frequent, followed by misdiagnosis and problems with medication.

When people are asked about the risk of having an adverse effect in the hospital, Greeks express the greatest mistrust, measured at 83%. The EU average stands at 50% and in the case of Spain, by 35%.

When the question refers to the risk in Primary Care, Greeks repeats the worst result, 78%. The EU average is 46% and 32% in Spain.

It is surprising that, despite the different kind of care, there is little difference between the estimation by the citizens of suffering harm in the hospital (35%) or primary care (32%).

Those are good results for Spain in terms of public confidence in the NHS, which compels us to continue working to not disappoint it.

Posted by Fernando Palacio
English version by Erika Céspedes

Monday, September 27, 2010

Detection of potential interactions by the electronic medical record: A new approach to improve patient safety

The European Journal of General Practice has published the article: Prevalence and typology of potential drug interactions occurring in primary care patients. Authors: López-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazarus D, Sanz GR.

The objective of this article is to determine the prevalence and type of potential drug interactions in primary care patients.

It is very interesting because its content is directly related to medical errors and their consequences, adverse effects and drug interactions in primary care. This field has a huge impact on the global patient safety due to the high number of visits, the level of prescription and other factors such as pluripathology.

The authors start from the difficulty of identifying and confirming the actual prevalence of drug interactions, to propose a preventive approach. It is acting on potential drug interactions identified by the electronic medical records (and confirmed by prescription -recipes used-), according to the evidence available, and using software that identifies patients likely to suffer these potential interactions. All this would be completed by a warning system, related to the medical record, that, in real time, allows the family physician identify the potential interaction, and with the automatic proposal of safe therapeutic alternatives. Every active ingredient that each patient can be taking simultaneously is analyzed.

The study confirms the existence of a serious safety problem for patients, because 1 in 20 Spanish citizens is subject to the risk of drug interaction. And, more important, with a high rate of serious or high risk interactions.

At the time of analysis 29.4% of the population took medication. Of these patients, 73.9% took more than one drug and, therefore, was at risk of interactions; more than a half of the potential interactions could be clinically important. However, the percentage of interactions observed is usual in the literature.

There are more interactions among people with chronic conditions, the elderly, females and polymedicated patients. The active ingredients most frequently involved were hydrochlorothiazide, ibuprofen and acenocumarol. Respect to interactions that should be avoided, the most common are combinations with omeprazole, acenocumarol and diazepam.

This approach and the results of this study provide us valuable information and, most of all, a new simple and practical approach, which should not be wasted by the professionals or the institutions involved, for the benefit of our patients.

Edited by José Saura Llamas
English version by Erika Céspedes

Saturday, September 25, 2010

Europe removes drugs containing rosiglitazone (Avandia®, Avandamet® and Avaglim®)

Finally, rosiglitazone (Avandia®) is no longer available in Europe.

In a previous post we discussed an article of The New York Times, which might help to explain why the FDA refuses its full withdrawal, although rosiglitazone is not better than pioglitazone, but causes more cardiovascular problems.

Yesterday, El País reported extensively on the ban, until Glaxo can "identify the group of patients in which the drug benefit exceeds the risks".

Avandia® sold 920 million Euros last year, and had arrived in 2006 to more than 2000 million. The question is: If the alert was given, and there are equally effective alternative medications, and safer, why was it still prescribed?

+ Info: - Spanish Agency for Drugs and Health Care Products (AEMPS):

Patient information note on the suspension of marketing of drugs containing rosiglitazone (Avandia ®, Avandamet ®, Avaglim ®)

Communication for professionals

- European Medicines Agency (EMA):

Press release: European Medicines Agency recommends suspension of Avandia, Avandamet and Avaglim

Questions and answers on the suspension of rosiglitazone-containing medicines (Avandia, Avandamet and Avaglim)

- In this blog:

GSK hid the rosiglitazone (Avandia) is associated with cardiovascular risk

GSK recibe una reprimenda de la FDA por ocultar datos sobre su antidiabético rosiglitazona (Avandia) (GSK receives a rebuke from the FDA for hiding data on its antidiabetic rosiglitazone Avandia)

Posted by Fernando Palacio
English version by Erika Céspedes

Monday, September 20, 2010

MedlinePlus: Talking with your doctor

This website presents, in the section "Health News", some advices for patients to prepare for consultation with their doctors so the patient can participate actively in the care process.

The objective of these tips is the patient to reflect about the importance of his participation, from the position of a formed patient, in the healthcare process. The patient should organize information about his disease to be transmitted to the doctor during the visit. He must also raise the questions necessary to understand their disease: what is happening, what is the evolution and how will be the treatment and the follow-up. After the consultation the patient should not have doubts about the information transmitted by the doctor.

In the news you will find links to other documents of interest for patients, related to the medical consultation:

Be an active member of your health care team (Food and Drug Administration)
How to talk to your child's Doctor (Nemours Foundation)
Tips for talking to your Doctor (American Academy of Family Physicians)

The column on the right contains links to topics of interest: Patient Safety, Patient Rights...

Posted by Lola Martín
English version by Erika Céspedes

Friday, September 17, 2010

Learning from the successes. Safety Meeting’ 10

The Observatory for Patient Safety, of the Quality Agency of Andalusia, has organized this conference on 23 September in Seville.

There will have place roundtables with suggestive titles such as "Improving safety is simple", "Improving safety takes 2 minutes" or "Report of successes".

On the other hand they will project the safe practice experiences sent before 15 September.

The Observatory organized with our group the 2nd Seminar for Patient Safety, held in Granada in 2009, so we know their good job. Therefore we encourage you to go to Seville.

The program and registration are available on this webpage.

Posted by Fernando Palacio
English version by Erika Céspedes

Saturday, September 11, 2010

The quality, security and content of telephone and face-to-face consultations: a comparative study

Telephone consulting is increasingly used to improve access to care and optimise resources. However, there remains a debate about how such consultations differ from face-to-face consultations in terms of content, quality and safety. To investigate this, a comparison of family doctors' telephone and face-to-face consultations was conducted.

106 audio-recordings, from 19 doctors in nine practices, of telephone and face-to-face consultations, stratified at doctor level, were compared using:

- The Roter Interaction Analysis Scale (RIAS), measuring the content

- The OPTION, that observes patient involvement in decision making

- A modified scale based on the Royal College of General Practitioners (RCGP) consultation assessment instrument, measuring quality and safety

- Patient satisfaction and training (empowerment) were measured using validated instruments.

Telephone consultations were shorter: 4.6 minutes, on average, compared to 9.7 minutes of the face-to-face ones.

The study concludes that although telephone consultations are convenient and judged satisfactory by patients and doctors, they may compromise patient safety more than face-to-face consultations and further research is required to elucidate this.

Telephone consultations are more suited to follow-up and management of chronic diseases than for acute management.

McKinstry B, Hammersley V, Burton C, Pinnock H, Elton R, Dowell J, et al. The quality, safety and content of telephone and face-to-face Consultations: a comparative study. Qual Saf Health Care. 2010 Aug; 19 (4) :298-303.

Posted by Lola Martín
English version by Erika Céspedes

Wednesday, September 8, 2010

Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes

Does any organization can implement a patient safety improvement programme?

What does it need to succeed? What results can be expected?

Quality and Safety in Health Care has published this original research outlining some answers.

UK researchers examined the perceptions of organizational readiness and its relation to the impact of the Safer Patients Initiative (SPI), a national initiative of the Health Foundation to address the patient safety improvement.

To learn about this perceptions they used a mixed-methods design, involving a survey and semistructured interviews with a sample of the improvement groups (consisting of senior executive leads, the principal SPI programme coordinator and the operational leads in each of the SPI clinical work areas) of the four organizations taking part in the first phase of SPI.

They obtained a response rate of 90% and 34 leaders participated in the interviews.

The questionnaire included items on perceptions of readiness in the following aspects:

1. Culture and attitudes toward quality and safety
2. Systems and infrastructure
3. Resource availability, measured on a scale from 1 (low preparation) to 6 (high preparation)

Further, it wondered about organizational stability, measured on a scale from 1 (stable) to 6 (turbulent).

It also asked for a specific score using a scale of 3 (significant strength) to -3 (significant weakness), of 15 factors such as financial resources, medical support, support from nurses, support from managers, etc.

The interviews contained open questions about the preconditions of the organization (culture, history of improvement, quality of information systems and measurement procedures, financial stability...) and the preparatory factors of the initiative (framework for program management, team's initial selection, clinician’s participation, communication and training before deployment...).

For the entire sample, culture and attitudes were better rated than systems and infrastructure and also than availability of resources. Everybody said that their previous history of improvement was important to take the initiative and all also experienced difficulties with the information and assessment systems’ capacity. The importance of the financial balance and the outcome was particularly important for executives.

With respect to specific factors, most were considered strengths but, while managers’ and nursing’s initial support was rated as good, medical initial support was rated worse (it was considered a weakness).

Personal interviews revealed that it is worth reflecting on the influence of the conditions at the beginning of the program. This reflection process gives the organization a valuable learning.

The highest score has the overall perception of preparation in an organization; the greatest impact presents the initiative on quality and security performance, greater sustainability of its benefits and greater success in its deployment in that organization, being leadership style an important factor in this preparation.

So this study, though preliminary, would suggest that prior to start these programmes, organizations would benefit from an assessment of their readiness with time spent in the preparation of its infrastructure, processes and culture. Furthermore, a better knowledge of these preconditions, that mark an organization as qualified to undertake the improvement work, would allow managers to set realistic expectations about the results of safety campaigns.

Burnett S, Benn J, Pinto A, Parand A, Iskander S, Vincent C. Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care 2010;19:313-317

Posted by Marisa Torijano
English version by Erika Céspedes

Sunday, September 5, 2010

Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene: Patient safety, a shared commitment, a general interest

The next September 17 will take place in Alicante a Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sociedad Española de Medicina Preventiva, Salud Pública e Higiene), in which also participates the Spanish Society for Quality Healthcare (Sociedad Española de Calidad Asistencial, SECA) and the Spanish Association of Health Risks Management and Patient Safety (Asociación Española de Gestión de Riesgos Sanitarios y Seguridad del Paciente, AEGRIS).

Their slogan: "Patient safety, a shared commitment, a general interest”.

Some of the most committed to patient safety will participate, including our colleague Carlos Aibar, who manages a workshop.

It is useful to review the programme and participants and, if you can go, the registration is free, in order of application.

+Info on this web page

Posted by Safe and Healthy
English version by Erika Céspedes

Thursday, September 2, 2010

Improving quality of antibiotics’ prescription in primary care: a qualitative evaluation of combined training intervention

BMC Family Practice publishes this paper focused on an intervention designed to change primary healthcare professionals’ antibiotic prescription habits.

The educational STAR program (Stemming the Tide of Antibiotic Resistance) has the aims of improving antibiotics’ prescription and to increase the awareness of the problem of antibiotic resistance among primary care physicians.

STAR program is composed of five main parts, complemented by a forum in the web about the course (part 6), and a reinforcement session (part 7) given approximately six months after completing the main program of the course.

Parts 1 and 2 include an online-introduction to antibiotic resistance and prescription. Participants present their own points of view on the subject. Clinical cases are also presented to discuss as well as some of most recent scientific evidence (graphics and abstracts). The objective of these two first parts is to raise clinicians’ awareness on how they treat common infections in everyday practice.

Part 3 consists of a practical seminar, where attendants meet in presence of a STAR instructor who contributes to the discussion about their prescription habits and data on resistances, collected from samples offered by professionals during the five to ten years previous to the study.

Part 4 presents online videos reflecting clinical settings or patient simulations to show key communication skills to employ in practice, useful for better understanding patients’ attitudes, expectations and worries.

In part 5 physicians are asked to describe three examples of their own clinical experience and to think them over, in order to consolidate the achieved knowledge.

The program’s effectiveness was evaluated in a randomized controlled study in which 244 primary care physicians and nurses took part. This text shows part of the study’s evaluation.

Evaluation was performed by a partly structuralized telephone interview, with digital data registration, to a 31 participants sample, by means of analysis of contents.

The majority of subjects reported higher awareness of antibiotic resistance, greater self confidence to reduce antibiotics’ prescription and at least some change in practice and attitude towards antibiotics’ prescription. Reported changes in practice included adoption of some policy to decrease prescription of antibiotics. Many physicians also reported their increased interest in patients’ expectances that contributes to improve the relationship between patient and physician.

The parts of the intervention that showed greatest influence to change professional’s behaviour were the update of available evidence, the simple and effective communication skills presented on online videos, and self reporting of antibiotic prescription data, combined with showing local resistance data.

Participants considered this educational intervention acceptable, necessary and feasible, obtaining a great impact and positive changes in attitudes and in clinical practice as a result of participation in STAR educational program.

Bekkers MJ, Simpson SA, Dunstan F, Hood K, Hare M, Evans J, et al. Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention. BMC Fam Pract. 2010;11:34.

Posted by Lola Martín
English version by Erika Céspedes