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

Again with blood glucose meters: Supplementary information

We recently echoed in this blog a warning from the Spanish Agency of Drugs and Health Care Products (AEMPS), referring to problems of interference in glucose meters.

Abbott Laboratories have corrected their test strips FreeStyle Lite, for not to interfere with certain medications at the time of measuring blood glucose in diabetic patients.

They have therefore changed the reactive enzyme, replacing PQQ-glucose-dehydrogensasa by glucose dehydrogenase-FAD, which is specific for the detection of glucose in blood.

To identify these new strips they have changed aspects of packaging and labeling, making it necessary to pay attention to these changes.

The Spanish Agency for Drugs and Health Care Products (AEMPS) has issued a supplementary information to the security note on possible errors in measurements of glucose in diabetic patients due to interference with certain treatments, which provides detailed information on laboratory changes.


See also in this blog:

Again with blood glucose meters

Beware with blood glucose meters


Posted by Juan José Jurado
English version of this post Jesús Moreno

The effects of on-screen, point of care computer reminders on processes and outcomes of care

A Cochrane review on on-screen computer reminders delivered to health professionals at the point of care, concludes that those ones produce only small to moderate improvements in both process and outcome of care.

Computer reminders are intended to help health care professionals to recall information that they may already know, but could forget easily when doing other activities of care. They also serve to support decisions, provide information or guidance in an accessible format at a particularly relevant. These reminders are able to address multiple topics, are automatic and come at the right time of care.

This Cochrane review found 28 studies that evaluated the effects of different on-screen reminders. The studies tested reminders to prescribe specific drugs, to warn about drug interactions, to provide vaccinations or to order tests.

The review found small to moderate benefits, that is, these reminders improved medical practice in a small percentage by measuring the results against the percentage of patients receiving care according to the reminder given to the professional (e.g. specific medication prescription, performance of a specific task such as sending to a medical specialist, etc.).

They also studied continuous process outcomes, for example, duration of treatment with antibiotics and various markers of disease or health status (e.g., mean blood pressure or cholesterol level). However, the results of improvement patients’ health also achieved small benefits.


Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care.. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001096. DOI: 10.1002/14651858.CD001096.pub2


See also in this blog: ¿Se cancelan las alertas sobre medicamentos en la prescripción electrónica?


Posted by Guadalupe Olivera
English version by Erika Céspedes

Again with blood glucose meters

To complete the warning published in the previous post on blood glucose meters, we have posted in sanoysalvo files a review made in the Area 6 of Madrid, which details issues such as reliability, calibration, interferences and frequent errors, that must be read by those who perform this type of techniques.

Click here to download the document.


Posted by Juan José Jurado and Fernando Palacio
English version by Jesús Moreno

Beware with blood glucose meters

The Spanish Agency for Drugs and Health Care Products has issued a safety note on June 18 warning on the risk of possible errors in measurements of glucose obtained with some blood glucose meters using the enzyme as a reagent pyrroloquinoline quinone glucose dehydrogenase (GDH-PQQ ), interfering in these results some medications.

Meters that use this enzyme are Accu-Chek Sensor®, Accu-Chek Compact Plus®, Accu-Chek Compact®, Accu-Chek Aviva®, Accu-Chek Aviva Nano® , Accu-Chek Voicemate®, FreeStyle Lite® and Freestyle Freedom Lite®.

Drugs wich may interfere are Extraneal® , Orencia®, Octagamocta® and Adept® 4%.

This same warning has been published by the FDA in August 2009 (FDA Public Health Notification: Potentially Fatal Errors with GDH-PQQ * Glucose Monitoring Technology).

Both notes report that the use of these meters in patients undergoing treatment with outlined in the table medications, can produce abnormally high results detecting substances other than glucose that are generated from the administration of these drugs.

Worth noting that these drugs are not used routinely in primary care settings because the conditions for which are shown are monitoring, most of them specialized care. These patients are those undergoing peritoneal dialysis (Extraneal), patients with certain immune deficiencies situations or undergoing bone marrow transplantation (Octagamocta), patients with rheumatoid arthritis (Orencia), or patients undergoing abdominal surgery (Adept).

It is important therefore not to use these blood glucose meters in these patients.

With respect to the use of blood glucose meters, we also note that a valid result can come conditioned by other aspects of this process:

• Assessing the need for prior calibration of the meter.
• Improper storage of test strips.
• Ambient temperature.
• Insufficient blood volume.

Also, each meter has different methodologies for testing. Therefore, it is not advisable to make comparisons of results between different commercial laboratories.


Posted by Juan José Jurado
English version by Jesús Moreno

Pharmacotherapeutic follow-up DaderWeb

The journal Atención Primaria have published the overall results during the first year of initiation and piloting a new Primary Care database accessible from DaderWeb.

This web application arises from the need to optimize all data related to the program Dáder. The program was designed by the Research Group on Pharmaceutical Care, University of Granada, in 1999, and is currently being used in different countries by hundreds of pharmaceutical professionals in thousands of patients. It is based on obtaining the patient's pharmaceutical record in the community pharmacy and the personal pharmaceutical monitoring (SFT) by detecting, preventing and resolving drug-related problems on a continuous, systematic and documented way. It cooperates with the patient and all professionals of the Health System, in order to achieve concrete results that improve the quality of life of patients.

This first year of initiation and piloting is aimed to improve the organization of the information provided, to avoid loss of it, to optimize the processing of data and, ultimately, to enhance the quality of the information stored in it by:

a) Preparation of records and collection of information about its activity,

b) Location and access to updated information and quality,

c) Communication between professionals.

Among the registration documents available in DaderWeb we distinguish the pharmaceutical intervention sheet (HIF), which refer to a possible pharmaceutical care across countries and fields on the detection and intervention on negative results associated with the use of drugs (RNM).

Among their findings, only in the field of primary care in Spain, 234 HIF sent (a RNM for HIF) by 27 community pharmacies, 147 patients involved, with a mean age of 66 years (SD 11.8) and 59.4% of women. The 88.5% of the RNM was clinically manifested when detected.

The most frequent RNM were related to the ineffectiveness of drug therapy, supporting the need for closer monitoring of clinical outcomes of medications.

As most prevalent causes of failure were identified the neglect (17.9%) and the not appropriate dose, regime or duration of treatment (13.7%). In the 16% of cases they did not identify any cause and in a 36.9%, although there was a problem in the application process, it was not specify in the default list provided by the HIF3.

In the 35.9% of cases the pharmacist intervened independently through direct patient education to resolve the RNM. After measuring the appropriate clinical variables indicating, in each case, the development of RNM, these were resolved in the 81.2% of the times.

To systematize the SFT has made great strides thanks to the Dáder program. The evaluation of the quality of the prescription allows to detect any differences, points of improvement and to develop and design appropriate interventions to optimize outcomes in the health field. The Dáder, certainly, is a huge step that should appeal to all community pharmacists in improving the SFT and to build on its steps.

Sabater-Hernández D, Faus D, Fikri-Benbrahim N, García-Cárdenas V. Resultados globales de la base de datos del Programa Dáder de Seguimiento Farmacoterapéutico: 2008. Aten Primaria. 2010;42:297-8.


Contribution by M ª José Montero Fernández. Primary Care Pharmaceutical, Area 4, Madrid.
English version by Jesús Moreno

Held the First Congress of the Health Blogosphere

As announced on this blog, last Monday June 14 was held in Madrid the 1st Congress of the Health Blogosphere.

We presented there our blog Safe and Healthy. The presentation can be downloaded here. It is a summary on what it is and what can be found in safeandhealthypatient.org (the English version of sanoysalvo.es).

The conference was a success of participation and contents, that is why we must thank the organizers.


Posted by Jesús Palacio
English version by Jesús Moreno

1st Congress of the Health Blogosphere: Madrid, June 14, 2010

The next June 14, 2010, the Instituto Carlos III, Madrid, will take place the 1st Congress of the Health Blogosphere, in wich veteran and expert bloggers are participating.

I quote below the reason for the call, in organizers words.

See you there.

"Why?

Knowledge has gone from the conferences and books to computer screens. Internet is the natural way of searching for professionals and users of the National Health System. To analyze the status of the health blogosphere and the initiatives in information exchange is getting more and more important. The Hispanic health blogosphere is very active and dynamic. The blogs, magazines and digital forums, live together with initiatives with high impact in the training of professionals and patients. This Congress aims to value the health blogosphere as a source of organized knowledge and as a key in a modern health system. The First Congress of the Health Blogosphere in Spain also intends to build an active discussion group integrated by the major health bloggers, soy they can work synergistically. This conference intends to be the first of a couple of meetings and actions to provide an integrative field for all users and players of the health blogosphere. The Congress will also serve to share ideas, tools and initiatives through a market of blogs and web initiatives with free acces. "


Posted by Jesús Palacio
English version by Erika Céspedes

Welcome to the English version of Sano y Salvo

Sano y Salvo is currently the only website focused on patient safety in primary care. We receive visits from all over the world, which has made us consider the publication of our contents in English.

So we have created the blog safeanhealthypatient.org, in which we will publish the translation of sanoysalvo.es posts.

Publication at this site of the spanish originals will not be exhaustive or synchronous. We will publish the translation of new posts and, as we can, some of the older posts.

Sano y Salvo is currently a collection of the most relevant items published about patient safety in primary care, both at the national (Spain) and international level. Our web searcher engine and the links on the right column allow anyone to find relevant contents and interesting experiences to improve patient safety in primary care.

Now we also consider making these material worldwide available, in English.


Posted by Jesus Palacio, editor of sanoysalvo.es and Erika Céspedes, manager of the English version published in safeandhealthypatient.org