An intervention model with self-assessment and subsequent multi-professional review might be effective and feasible to improve drug safety in primary healthcare. A survey-based evaluation of SÄKLÄK2.

RATIONALE, AIMS, AND OBJECTIVES: Drug-related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi-professional intervention model aiming at improving drug safety in primary health care. The objective of this study was to elucidate the perceptions of the participants' regarding the efficiency of the intervention and the feasibility to introduce this model widely. METHOD: SÄKLÄK2 is a multi-professional intervention model in primary health care in Sweden that consisted of self-assessment, peer-review, written feedback, and agreements for change. Web-based surveys were sent to both the management of participating primary health care centres (PHC) and to reviewers. The participating PHCs were fairly well-staffed and had a high interest in improvement work. Descriptive analysis and content analysis was used. RESULTS: For the PHC management, the following categories were formed: Comprehensive project, Time-consuming, Multi-professional character, Relevant action agreements, and Feasible to implement. For the reviewers, the following categories were formed: Multi-professional character, Relevant action agreements, Feasible to implement, Useful self-assessment questionnaire, and Valuable visit at the PHC. There was a high degree of consistency between the PHC management and the reviewers' answers, especially regarding the efficiency of the model to improve drug safety and the feasibility to implement it on a broad front. CONCLUSION: SÄKLÄK2, a model with self-assessment, peer review, written feedback, and the formation of action agreements was considered by both the participating heads of the PHC centres and the reviewers to be effective to improve drug safety in primary health care. Though time-consuming, this multi-professional model was considered to be feasible to implement on a broad front and might thereby be one way of working with quality improvement regarding drug safety.

Clinical practice visits: a rapid review.

BACKGROUND: Practice visits are a peer review activity where one or more healthcare providers visit the practice of another in the same field. The purpose of this exercise is for visitors to observe and review a host's practice in a non-punitive manner and provide them with constructive feedback as required; ultimately to improve practice quality and patient care. METHODS: A rapid review of three biomedical databases was conducted to identify relevant literature published up until 9 April 2018. There were no limits placed on publication date or publication type. Two authors were responsible for study selection and data extraction using a priori inclusion criteria and extraction templates. Study details and key findings were reported narratively and in tables. RESULTS: A total of nine publications, reporting outcomes for eight study groups, were identified as eligible for inclusion in this rapid review. Of these eight, six were observational studies, one was a longitudinal study and one was a randomized controlled trial. Practice visits were considered useful in identifying areas of improvement in professional practice; however, the rate at which these improvements were elicited varied greatly between the included studies. Overall, both hosts and visitors gained insight from the practice visit process and in general their experiences were positive. CONCLUSIONS: Based on the evidence provided by the included studies, recommendations for an effective practice visit can be made. Importantly, the poor quality and age of the literature from which these recommendations are based should be considered.

Effects of an intervention (SÄKLÄK) on prescription of potentially inappropriate medication in elderly patients.

Background: Polypharmacy is known to increase the risk for drug-related problems, and some drugs, potentially inappropriate medications (PIMs), are especially troublesome. Objective: To analyse the effects on prescription of PIMs of the SÄKLÄK project, an intervention model created to improve medication safety for elderly patients in primary care. Method: The SÄKLÄK project was a multiprofessional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. Five Swedish primary care centres participated in the intervention and five served as comparison group. Data were collected from the Swedish Prescribed Drug Register on PIMs (long-acting benzodiazepines, anticholinergics, tramadol, propiomazine, antipsychotics and non-steroidal anti-inflammatory drugs) prescribed to patients aged 65 years and older. Total number of patients and change in patients using PIMs before and after intervention with-in groups was analysed as well as differences between intervention and comparison group. Results: A total of 32566 prescriptions of PIMs were dispensed before the intervention, 19796 in the intervention group and 12770 in the comparison group. After intervention a decrease was seen in both groups, intervention-22.2% and comparison-8.8%. All groups of PIMs decreased, except for antipsychotics in the comparison group. For the intervention group, a significant decrease in mean dose/patient was seen after the intervention but not in the comparison group. Conclusion: Our study shows this method has some effects on prescription of PIMs. The evaluation indicates this is a feasible method for improvement of medication use in primary care and the method should be tested on a larger scale.

Management time for patients with acute cerebrovascular disease before and after re-accreditation of Grade Ⅲ Class A in a general hospital / 中华全科医师杂志

Objective To compare the change of management time for patients with acute cerebrovascular disease before and after re-accreditation of Grade Ⅲ Class A in a general hospital.Methods Electronic medical records of 490 patients diagnosed as acute cerebrovascular disease(215 cases of cerebral infarction,275 cases of cerebral hemorrhage) managed in Zhongnan Hospital of Wuhan University from June 2015 to July 2016 were collected,including 262 patients managed before re-accreditation (group A,June 2015 to December 2015) and 228 patients admitted after re-accreditation (group B,January 2016 to July 2016).In group A,there were 109 cases of cerebral infarction and 153 cases of cerebral hemorrhage(68 caused by trauma);in group B there were 106 cases of cerebral infarction and 122 cases of cerebral hemorrhage(54 caused by trauma).The time in emergency department (ED time),time waiting for admission (admission time) and the total management time (total time) were analyzed and compared between two groups.Results The ED time in group A and group B was 44.5 (30.0,71.5) and 39.0 (20.3,69.0) min (Z =-2.103,P =0.036) respectively;the admission time was 35.0 (25.8,50.0) and 39.0 (27.3,55.8) min(Z =-2.211,P=0.027);and total time was 85.0(62.8,120.0)and 82.5(61.0,119.0) min(Z =-0.356,P =0.722) in two groups respectively.For patients of cerebral infarction in group A and B the ED time was 49.0 (33.5,81.5) and 41.0 (29.8,74.3) min(Z =-1.872,P =0.061);the admission time was 37.0(27.0,52.0) and 36.0(25.0,52.3) min(Z =-0.516,P =0.606);and total timewas97.0(69.5,131.0)and 83.5(62.0,118.3) min(Z=-1.914,P=0.056).For patients of cerebral hemorrhage in group A and B,the ED time was 42.0 (28.0,64.0) and 35.0 (17.8,65.0) min (Z=-1.426,P =0.154);the admission time was 34.0(24.5,49.0)and 41.0(31.0,61.0) min (Z=-3.353,P =0.001);and total time was 79.0(58.0,108.0) and 82.0(60.0,120.8) min (Z =-1.052,P =0.293).Conclusions After re-accreditation of Grade Ⅲ Class A Hospital the total waiting time for patients of cerebral infarction is decreased significantly in emergency department,however,for patients of cerebral hemorrhage the waiting time for admission is longer.

Informatização da avaliação de óbitos em trauma / Computerization for assessment to trauma deaths

OBJETIVO: Auxiliar comissões de revisão de casos de óbito com um registro de óbito informatizado capaz de calcular automaticamente índices de trauma e gerar análises relevantes para avaliação dos casos e tomada de decisão. MÉTODOS: Desenvolvimento de aplicação web utilizando modelo de software como serviço para computação em nuvem com requisitos levantados por meio de revisão bibliográfica. RESULTADOS: Implementação de aplicação web com interface amigável ao usuário e de fácil utilização, com ferramentas para avaliação e análises dos dados de óbito em trauma. CONCLUSÃO: A aplicação possui diversas funcionalidades para apoio às avaliações das comissões de óbito. A análise do caso de forma global pela comissão de avaliação de óbito, identificando os problemas que eventualmente possam ter ocorrido e as medidas que poderiam ter sido feitas para que o resultado final não fosse o óbito do paciente. Desta forma, pode-se determinar quais as estratégias de correções que podem ser feitas.

OBJECTIVE: development of computerized record of the panel reviews of trauma mortality that can automatically calculate trauma indexes and generate relevant analyzes to assess clinical cases and decision making. METHODS: web application development using software as a service for cloud computing. RESULTS: Pilot project tested in Redcap contributed the implementation of web application user-friendly interface and easy to use, with tools for evaluation and analysis of death data in trauma cases. CONCLUSION: The application developed and pre-tested in Redcap has several features to support assessments of death committees. The analysis of the case globally by trauma mortality review panel, identifying the problems which might have occurred and the measures that could have prevented the death of the patient. Thus, one can determine which strategies corrections that can be made.