Validation of a Reduced Set of High-Performance Triggers for Identifying Patient Safety Incidents with Harm in Primary Care: TriggerPrim Project.

OBJECTIVE: The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC). METHODS: This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: ( a ) presence of each of 19 specific computer-identified triggers in the EMR and ( b ) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression. RESULTS: The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7). CONCLUSIONS: The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.

Is primary care a patient-safe setting? Prevalence, severity, nature, and causes of adverse events: numerous and mostly avoidable.

Knowing the frequency and characteristics of adverse events (AEs) is key to implementing actions that can prevent their occurrence. However, reporting systems are insufficient for this purpose and epidemiological studies are also required. Currently, the reviewing of clinical records is the gold standard method for knowing the frequency and characteristics of AEs. Research on AEs in a primary care setting has been limited and primarily focuses on specific types of events (medication errors, etc.) or patients. Large studies that search for any kind of AE in all patients are scarce. This study aimed to estimate the prevalence of AEs in the primary care setting and their characteristics. SETTING: all 262 primary health-care centres in the Madrid region (Spain) during the last quarter of 2018. DESIGN: cross-sectional descriptive study. Eligible population: subjects over 18 years of age who attended medical consultation over the last year (N = 2 743 719); a randomized sample stratified by age. MAIN OUTCOMES: age, sex, occurrence of an AE, number of consultations in the study period, avoidability, severity, place of occurrence, type of event, and contributory factors. The clinical records were reviewed by three teams, each composed of one doctor and one nurse trained and with expertise in patient safety. The SPSS software package (version 26) was used for the statistical analyses. The evaluators reviewed 1797 clinical records. The prevalence of AEs over the study period was 5.0% [95% confidence interval (CI): 4.0%‒6.0%], with higher values in women (5.7%; 95% CI: 4.6%‒6.8%;P = 0.10) and patients over 75 years of age (10.3%; 95% CI: 8.9%‒11.7%; P < 0.001). The overall occurrence per hundred consultations was estimated to be 1.58% (95% CI: 1.28%‒1.94%). Of the detected AEs, 71.3% (95% CI: 62.1%‒80.5%) were avoidable. Additionally, 60.6% (95% CI: 50.7%‒70.5%) were categorized as mild, 31.9% (95% CI: 22.4%‒41.4%) as moderate, and 7.4% (95% CI: 2.1%‒12.7%) as severe. Primary care was the occurrence setting in 76.6% (95% CI: 68.0%‒85.2%) of cases. The overall incidence of AEs related to medication was 53.2% (95% CI: 50.9%‒55.5%). The most frequent types of AEs were prescription errors (28.7%; 95% CI: 19.5%‒37.9%), followed by drug administration errors by patients (17.0%; 95% CI: 9.4%‒24.6%), and clinical assessment errors (11.7%; 95% CI: 5.2%‒18.2%). The most common contributory factors were those related to the patient (80.6%; 95% CI: 71.1%‒90.1%) and tasks (59.7%; 95% CI: 48.0%‒71.4%). A high prevalence of AEs (1 in 66 consultations) was observed, which was slightly higher than that reported in similar studies. About 3 out of 4 such events were considered to be avoidable and 1 out of 13 was severe. Prescription errors, drug administration errors by patients, and clinical assessment errors were the most frequent types of AEs. Graphical Abstract.

[PAPPS update on older people 2022]. / Actividades preventivas en el mayor. Actualización PAPPS 2022.

This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.

[PAPPS GdT Major 2020 Update]. / Actualización PAPPS GdT Mayor 2020.

In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.

Actividades preventivas en los mayores. Actualización PAPPS 2018 / No disponible

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Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca / Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure

Objetivo: Comprobar si el proceso asistencial en Atención Primaria de Salud (APS), definido por 7 criterios de correcta atención, influye en el riesgo de hospitalizaciones evitables por Ambulatory Care Sensitive Conditions (ACSH) por insuficiencia cardíaca (IC). Diseño: Estudio de casos y controles que analizó el riesgo de hospitalización por IC. Factor de exposición: proceso asistencial de APS. Emplazamiento: Área sanitaria de la Comunidad de Madrid (n = 466.901). Participantes: Pacientes mayores de 14 años con el registro del diagnóstico de IC en la historia clínica electrónica de APS (n = 3.277) antes del 1 de enero de 2007. Los casos fueron pacientes que ingresaron en el hospital de referencia por IC durante 2007. Los controles no requirieron ingreso. Mediciones principales: Riesgo de ACSH por IC relacionado con el proceso asistencial considerado tanto de forma conjunta como por cada uno de los criterios. Diferencias en complejidad clínica mediante Adjusted Clinical Group(ACG). Resultados: Doscientos veintisiete ingresos por IC frente a un grupo control de 3.050 pacientes. El peso medio de ACG fue mayor en los casos. Los controles tuvieron mayor cumplimentación de criterios, pero ninguno cumplió los 7. Solo en 2 de los criterios se observó menor riesgo de ACSH. A medida que no se cumplimentaba progresivamente cada criterio, el riesgo de ingresar aumentó (OR = 1,33; IC 95%: 1,19-1,49). Conclusión: La calidad del proceso asistencial en APS influyó en el riesgo de ingreso por IC (AU)

Objective: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Design: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Location: Health area of the region of Madrid (n=466.901). Participants: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n = 3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. Main measurements: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. Results: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Conclusion: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF (AU)

[Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure]. / Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca.

OBJECTIVE: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). DESIGN: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. LOCATION: Health area of the region of Madrid (n=466.901). PARTICIPANTS: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. MAIN MEASUREMENTS: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. RESULTS: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). CONCLUSION: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF.

Factores de riesgo de asma de inicio entre los 12 y 40 años. Resultados del estudio FENASMA / Risk Factors for Asthma Onset Between the Ages of 12 and 40. Results of the FENASMA Study

Objetivos: Describir el perfil clínico de los pacientes con asma e identificar posibles factores de riesgopara su desarrollo en sujetos mayores de 12 años.Métodos: Estudio multicéntrico de casos y controles. Se reclutó como casos a sujetos entre 12 y 40 añoscon diagnóstico de asma, con inicio de los síntomas después de los 12 años. Se seleccionó como controlesa sujetos entre 12 y 40 años que no tenían asma durante la infancia y que no presentaban síntomas deasma en el momento de realizar el estudio.Resultados: Se evaluó a 923 sujetos, 247 casos y 671 controles. El 54,9% de ellos eran mujeres. La media deedad de los casos era 28,3±8,2 y la de los controles, 30,8±7,1 años (p < 0,001). En el análisis de regresiónlogística se observó que los factores determinantes de la presencia de asma fueron la hipersensibilidada animales o a otros alérgenos, la presencia de rinitis, los antecedentes familiares de asma, la profesiónde riesgo/exposición a irritantes y la hipersensibilidad/intolerancia a AINE. En dicho análisis se demostrótambién que la edad era un factor de protección, así como el nivel de estudios.Conclusiones: Los factores de riesgo para el desarrollo de asma en la edad adulta son la hipersensibilidada animales o a otros alérgenos, la rinitis, los antecedentes familiares de asma, la profesión deriesgo/exposición a irritantes y la hipersensibilidad/intolerancia a AINE, mientras que la edad y el nivelde estudios son factores protectores (AU)

Objectives: To describe the clinical profile of patients with asthma and to identify possible risk factors forits development in subjects over the age of 12.Patients and methods: Amulticenter study of cases and controls. Recruited for inclusion were case subjectsbetween the ages of 12 and 40 diagnosed with asthma, with an onset of symptoms after the age of 12.Control subjects were selected, with ages between 12 and 40, who did not have childhood asthma anddid not present symptoms of asthma at the time of the study.Results: We evaluated 923 subjects: 247 cases and 671 controls. 54.9% were women. Mean age of thecases was 28.3±8.2; mean age of controls was 30.8±7.1 (p < 0.001). In the logistic regression analysis,it was observed that the determining factors for the of the presence of asthma were hypersensitivity toanimals or other allergens, presence of rhinitis, family history of asthma, occupational risk/exposure toirritants and the hypersensitivity/intolerance to NSAIDs. In said analysis, it was also demonstrated that age was a protection factor, as well as level of education. Conclusions: The risk factors for the development of asthma at an adult age are hypersensitivity to animalsor other allergens, rhinitis, family history of asthma, occupational risk/exposure to irritants and thehypersensitivity/intolerance to NSAIDs, while age and level of education are protection factors (AU)

¿Qué pretenden estimar los estudios de pronóstico? Revisión de la metodología en la investigación pronostica / What do prognostic studies estimate? Survey of methods in published prognostic research

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Seasonal and Pandemic A (H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital.

Influenza vaccination coverage among health-care workers (HCWs) remains the lowest compared with other priority groups for immunization. Little is known about the acceptability and compliance with the pandemic (H1N1) 2009 influenza vaccine among HCWs during the current campaign. Between 23 December 2009 and 13 January 2010, once the workplace vaccination program was over, we conducted a cross-sectional, questionnaire-based survey at the University Hospital 12 de Octubre (Madrid, Spain). Five hundred twenty-seven HCWs were asked about their influenza immunization history during the 2009-2010 season, as well as the reasons for accepting or declining either the seasonal or pandemic vaccines. Multiple logistic-regression analysis was preformed to identify variables associated with immunization acceptance. A total of 262 HCWs (49.7%) reported having received the seasonal vaccine, while only 87 (16.5%) affirmed having received the pandemic influenza (H1N1) 2009 vaccine. "Self-protection" and "protection of the patient" were the most frequently adduced reasons for acceptance of the pandemic vaccination, whereas the existence of "doubts about vaccine efficacy" and "fear of adverse reactions" were the main arguments for refusal. Simultaneous receipt of the seasonal vaccine (odds ratio [OR]: 0.27; 95% confidence interval [95% CI]: 0.14-0.52) and being a staff (OR: 0.08; 95% CI: 0.04-0.19) or a resident physician (OR: 0.16; 95% CI: 0.05-0.50) emerged as independent predictors for pandemic vaccine acceptance, whereas self-reported membership of a priority group was associated with refusal (OR: 5.98; 95% CI: 1.35-26.5). The pandemic (H1N1) 2009 influenza vaccination coverage among the HCWs in our institution was very low (16.5%), suggesting the role of specific attitudinal barriers and misconceptions about immunization in a global pandemic scenario.