Patient safety in primary care: a survey of general practitioners in the Netherlands

Sander Gaal,Michel Wensing,Wim Verstappen

doi:10.1186/1472-6963-10-21

Abstract

BackgroundPrimary 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.MethodsA 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.ResultsA 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.ConclusionThe 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.

Highlights

Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be broad
A set of salient points was selected and put into a survey which was reviewed by three experts
The aforementioned clinical cases correlate with a taxonomy of patient safety in primary care [10]

Summary

Introduction

Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be broad. Previous research on safety in primary care has focused on medication safety and incident reporting. The focus of research is mostly upon hospital care [2], most patients attain their healthcare in primary care settings, in countries with a strong primary care system [3]. Primary care has been found to be relatively safe incidents do occur in this setting as well [4]. The occurrence of incidents in primary healthcare has been estimated to be somewhere between 5 and 80 times per 100,000 consultations [5]. Different definitions of patient safety and a patient safety incident have been published.

Methods

Results

Discussion

Conclusion