ABSTRACT
BACKGROUND: Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. METHODS: Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants' demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. RESULTS: Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (- 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39-3.35), and by 13.75 (2.41-354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. CONCLUSION: A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. TRIAL REGISTRATION: It was retrospectively registered with ( ISRCTN41911128 , 31/12/2010).
Subject(s)
Family Practice/education , Primary Health Care , Quality Improvement , Safety Management , Adult , Female , Humans , Male , Middle Aged , Risk ManagementABSTRACT
OBJECTIVE: To assess the effect of stressful life events (SLE) on the monitoring of patients with essential hypertension. DESIGN: Observational and prospective. SETTING: Primary care. PARTICIPANTS: 236 hypertense patients selected by systematic randomised sampling. MEASUREMENTS: Age, sex, marital status, cultural level, kind of family, presence of SLE, social support, blood pressure, severity of hypertension, tobacco consumption, alcohol, presence of diabetes, hypercholesterolaemia, body mass index, compliance with hypertension treatment. RESULTS. Mean age was 63.51 (62.05; 64.96), with 66.1% being women and 33.9% men. 48.7% of the patients referred to some SLE during the follow-up. These reached a mean of 47.65 (33.16; 62.15) life change units (LCU). Patients with high-impact SLE (>150 LCU) had a significant increase of 10.91 mm Hg (0.43; 21.40) in their systolic blood pressure and of 9.48 beats per minute (3.78; 15.19) in their heart rate, after monitoring for possible factors of confusion. We observed a similar trend for diastolic pressure, but this did not reach statistical significance. CONCLUSION: The presence of SLE has a negative effect on systolic blood pressure in hypertense patients.
Subject(s)
Adaptation, Psychological/physiology , Cardiovascular Physiological Phenomena , Cardiovascular System/physiopathology , Hypertension/physiopathology , Life Change Events , Stress, Psychological/physiopathology , Aged , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Objetivo. Valorar el efecto de los acontecimientos vitales estresantes (AVE) sobre el control de pacientes con hipertensión arterial esencial. Diseño. Observacional y prospectivo. Emplazamiento. Atención primaria. Participantes. Un total de 236 hipertensos seleccionados por muestreo aleatorio sistemático. Mediciones. Edad, sexo, estado civil, nivel cultural, tipo de familia, presencia de AVE, apoyo social, presión arterial, gravedad de la hipertensión, consumo de tabaco, alcohol, presencia de diabetes, hipercolesterolemia, índice de masa corporal y cumplimiento del tratamiento antihipertensivo. Resultados. La media de edad fue de 63,51 años (62,05-64,96), siendo la mayoría mujeres (66,1 por ciento). Un 48,7 por ciento de los pacientes refirieron algún AVE durante el seguimiento, y éstos alcanzaron una media de 47,65 (33,16-62,15) unidades de cambio vital (LCU). Los pacientes con AVE de alto impacto (>150 LCU) presentaron un incremento significativo de 10,91 mmHg (0,43-21,40) en la presión arterial sistólica y de 9,48 lat/min (3,78-15,19) en la frecuencia cardíaca, tras controlar por los posibles factores de confusión. Asimismo, observamos una tendencia similar respecto de la presión arterial diastólica, pero sin alcanzar significación estadística. Conclusiones. La presencia de AVE empeora el control de la presión arterial sistólica en pacientes hipertensos (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Cardiovascular Physiological Phenomena , Life Change Events , Stress, Psychological , Prospective Studies , Cardiovascular System , Adaptation, Psychological , Hypertension , Heart RateABSTRACT
OBJECTIVE: To quantify differences between general practitioners (GPs) and gynaecologists in the technique of insertion and follow-up of the intra-uterine device (IUD). DESIGN: Multicentred, descriptive, longitudinal study. SETTING: Two urban health centres and a family guidance clinic. PARTICIPANTS: Target population (n = 1700) between January 1993 and January 1996. Estimated mean of complications was 25%. Sample size was 247 for alpha = 0.05 and 1-alpha = 0.95. The sample was extended to 300 to allow for possible losses of files, estimated at 20%. MEASUREMENTS AND MAIN RESULTS: The variables age, sex, marital status, educational level, parity, abortions, previous contraception, type of job, type of IUD, post-insertion and follow-up complications, subjective evaluation, removal and average follow-up time, were analysed. 158 (54.9%) of the 288 IUDs finally studied were inserted by GPs, and 130 (45.1%) by gynaecologists. 69.5% were anchor-shaped, and 30.5% T-shaped. In 85.5% no immediate complications were found. Mean follow-up time was 22.67 months (CI 95%, 21.3-24.0), during which time 36.6% had complications detected, which led to removal of the device in 22.3% of complications. We found no statistically significant differences between the two populations for age, marital status, subjective evaluation, number of abortions, parity or previous contraception. Likewise, no differences between G.P.s and gynaecologists were detected for post-insertion or follow-up complications, percentage of IUDs removed, or period of time evaluated. There were differences found for the type of IUD used, with more anchor-shaped IUDs in primary care. There were no differences for the type of IUD or complications requiring its removal. CONCLUSIONS: In the population studied we found no differences in immediate or later complications between IUDs inserted by GPs and by gynaecologists.
