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Background Little is known about adverse events (AEs) that occur between physician visits for ambulatory chronic disease patients. An automated telephone self-management support programme for a diverse population of diabetes patients was implemented to capture AEs, describe the self-management domains from which they emanate and explore contributing causes. Methods AEs and potential AEs (PotAEs) were identified among 111 ethnically diverse diabetes patients. An AE is an injury that results from either medical management or patient self-management; a PotAE is an unsafe state likely to lead to an event if it persists without intervention. Medical record reviews were conducted to ascertain which self-management domain was involved with the event and to explore contributing causes. Results Among the 111 patients, 86% had at least one event detected over the 9-month observation period. 111 AEs and 153 PotAEs were identified. For all events, medication management was the most common domain (166 events, 63%). Only 20% of events reflected a single contributing cause; in the remaining 80%, a combination of system, clinician and patient factors contributed to their occurrence. Patient actions were implicated in 205 (77%) events, systems issues in 183 (69%) events and inadequate physician–patient communication in 155 (59%) events. Aside from communication, primary care clinician actions contributed to the occurrence of the event in only 16 cases (6%). Conclusions Our findings reveal a complex safety ecology, with multiple contributing causes for AEs and PotAEs among ambulatory diabetes patients. Moreover, patients themselves seem to be key drivers of safety and of AEs, suggesting that patient-level self-management support and patient-centred communication are critical to AE prevention. [ABSTRACT FROM PUBLISHER]

Background The publication of the report “To err is human: building a safer system” by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patient's perception and opinion about care safety in hospitals. Methods We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patient's safety perception published between 1989 and 2006. Results From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patient's opinions about the management and disclosure of adverse events and proposals to prevent them. Conclusions The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs. [ABSTRACT FROM PUBLISHER]

Objectives To evaluate the nature of patient experience input and its perceived usefulness to members of a national Advisory Committee in making decisions about the efficacy and safety of new interventional procedures. Design Survey of Advisory Committee members about the nature and usefulness of patients' responses to a patient experience semistructured questionnaire. Setting Interventional Procedures Programme, NICE. Participants 16 Committee members who assessed responses to 73 patient experience questionnaires. Main outcome measures Judged nature and usefulness of patient responses to different questions about the experience of patients in using one of nine different procedures. Findings Most patient responses were scored as useful: <20% were scored as ‘unhelpful’ or ‘very unhelpful.’ Committee members felt that patient responses most often supported other evidence but provided no new insights (52–68% of responses for 11 of the 12 questions). Responses to one question (effects of the procedure on specified areas of life) gave new and original evidence which was not present in the literature or expert opinions in 7% cases. Responses to eight of the 12 questions provided insights into sociocultural or equalities issues in 1–7% of cases. Conclusions Obtaining patient experience to inform guidance development is complex but provides generally useful supporting evidence and some new insights not available from other evidence. Further research should aim to further develop and validate different methods to obtain patient experience input. The impact of patient experience information on how the Committee decides about whether a procedure is efficacious and/or safe should be made explicit. [ABSTRACT FROM PUBLISHER]

Background In several breast cancer research environments, there was a need to develop a questionnaire that would (1) provide data on how breast cancer patients experience healthcare services, (2) address issues corresponding with patients' needs and expectations and (3) produce useful data for quality assessment and improvement projects aimed at breast cancer care. This article describes the first part of the quantitative process of item selection, instrument construction and optimisation based on the results of a pilot questionnaire. Methods Based on qualitative research, a pilot questionnaire with items formulated as “performance” and “importance” statements was developed and sent to all breast cancer patients operated on in the previous 3–15 months in five participating hospitals. Reduction criteria, exploratory factor analysis and reliability analysis were used as part of the process of instrument optimisation. Results Of the 637 questionnaires sent out, 299 (47%) were returned and 276 (43%) were used for analyses. Out of the 72 quality items included in the pilot questionnaire, 42 items did not meet the inclusion criteria for the revised version. The remaining items refer to the factors patient education regarding aspects related to postoperative treatment, services by the breast nurse, services by the surgeon, patient education regarding activities at home and patient education regarding aspects related to preoperative treatment (Cronbach α=0.70–0.89). Conclusions In this study, the number of items to be included in the self-administered questionnaire was reduced. The resulting set of items that determines patients' perceptions on quality of breast cancer care is easy to complete and enables anonymous responses. Further research can be aimed at establishing the reliability of the current questionnaire. [ABSTRACT FROM PUBLISHER]

Problem Chronic kidney disease is increasingly recognised in the UK, leading to a greater demand for specialist services. Traditional means of meeting this demand rely on GP referral of patients to see a nephrologist. Hospital assessment may be inconvenient for patients and inefficient for health services. Setting 17 general practices and a secondary care nephrology service in Bradford, UK. Design A before and after evaluation comparing nephrology referrals from implementation and non-implementation practices following the introduction of electronic consultations (e-consultations) for chronic kidney disease. Key measures for improvement The number, appropriateness and quality of new referrals (paper and electronic) from primary care, the timeliness of responses and the satisfaction of patients and health professionals with the new service. Strategies for change Electronic sharing of primary care electronic health records with the nephrology service was introduced to implementation practices. Participating GPs attended education workshops and received paper and e-guidance about the new service. Effects of change There was a significant reduction in paper referrals from implementation practices. E-consultation provided nephrologists with access to more clinical information. GPs reported that the service was convenient, provided timely and helpful advice, and avoided outpatient referrals. Specialist recommendations were well followed, and GPs felt more confident about managing chronic kidney disease in the community. Lessons learnt E-consultation promotes effective management of patients with mild-to-moderate chronic kidney disease in primary care, allowing specialist resources to be directed towards supporting patients with more complex needs. There is a potential role for e-consultation in other chronic disease specialties. [ABSTRACT FROM PUBLISHER]

Background Patients referred to secondary care in the UK often wait many months to be seen, and the UK government has announced various initiatives to address this issue. Since 2002, we have developed an email referral system which allows some neurological referrals to be managed by advice and investigations rather than by a conventional hospital clinic appointment. This system has previously been shown to reduce clinic attendances and to be acceptable to patients and their general practitioners (GPs). Aim To analyse the effects of an email triage system on waiting times, cost of care and safety over 5 years. Methods Referral numbers and waiting times for clinics using this system were analysed. Cost was determined by comparing detailed costs with those of conventional care. Safety was analysed by examining the GP records of all patients referred from a single practice who had been dealt with by advice or investigation, noting deaths, re-referrals and changes in diagnosis. Results Waiting times fell from 72 to 4 weeks, despite an increase in referrals. The cost per patient of email referral was about £100, compared with £152 for conventional care, a 35% reduction. Safety data on 120 individuals showed a minor change in diagnosis in three. Discussion This system is safe, effective (in reducing waiting times) and efficient. It enables neurologists to focus on patients with significant neurological disease and, if applied more widely, could reduce costs and waiting times for neurology services in the UK. [ABSTRACT FROM PUBLISHER]

Objective To analyse the frequency of adverse events to treatment reported by patients in relation to consultation time, attention from their usual doctor and information provided by their doctor about treatment. Design Descriptive study. Patients were invited to respond to a telephone survey. Setting 21 Primary Care health centres in Spain. Participants 15 282 patients attended by GPs or paediatricians (error of 1% for p=q=0.50, α 95%) were selected at random from the total consultations recorded in 1 month. For sampling, quotas were assigned for type of attention, age and sex. In the case of children (under 14 years), the survey was answered by their parents. Main outcome measures Patients' report on frequency of unexpected or adverse reaction to a treatment; whether informed or not about possible complications of the treatment and precautions to take; consultation time; and whether or not patient is usually seen by the same doctor. Results 1557 (17.6%, CI 95% 16.8 to 18.4%) of the adults and 867 (13.7%, 95% CI 12.8 to 14.5%) of the children reported adverse or unexpected reactions to the treatment according to patients' reports. Consultation time (OR 0.5, 95% CI 0.4 to 0.5), doctor rotation at the health centre (OR 2.04, 95% CI 1.85 to 2.25) and information on treatment precautions (OR 0.47, 95% CI 0.43 to 0.53) determine the higher risk of adverse reactions to treatment. Conclusions Planning at health centres should involve the monitoring of mean consultation time and doctor rotation as indirect indicators of safety. Furthermore, protocols related to the information provided to patients should be reviewed. [ABSTRACT FROM PUBLISHER]

Background While the chronic care model has been extensively used for the management of patients with diabetes in non-academic, primary care settings, it is not clear whether this model can be used effectively in academic, specialty clinics for other chronic disorders. Methods Through the Academic Chronic Care Collaborative, the chronic care model was introduced to help manage patients with osteoarthritis in an academic rheumatology service with seven prespecified goals. These goals included measurements of Western Ontario MacMaster (WOMAC) osteoarthritis scores, self-efficacy scores and exercise time. Results Five a priori goals were achieved in this study: average WOMAC scores less than 1000 mm as measured on a visual analogue scale, average self-efficacy score of less than 5 mm, average exercise time greater than 90 min, more than 40% of patients exercising at least 60 min per week and a 20% improvement in self-efficacy scores. However, a 20% improvement in WOMAC scores and a 60% completion of documented self-management goals in our patients were not achieved. Our inability to achieve our self-management goal underscores the fact that we have not yet fully implemented the chronic care model into our practice. The inability to detect a 20% improvement in WOMAC scores in the context of having reached our absolute WOMAC goal at baseline suggests a probable ceiling effect for this measure. Conclusions The chronic care model can be effectively introduced into an academic specialty service and can be used effectively in the management of patients with non-diabetic disorders, in this case osteoarthritis. [ABSTRACT FROM PUBLISHER]

Background Clinical practice guidelines (CPG) are important tools for improving patient care. Patient and public involvement is recognised as an essential component of CPG development and implementation. The Guideline International Network Patient and Public Involvement Working Group (G-I-N PUBLIC) aims to support the development, implementation and evaluation of guideline-oriented patient and public involvement programmes (PPIPs). Objective To develop an international practice and research agenda on patient and public involvement in CPG. Method 56 CPG developers, researchers, and patient/public representatives from 14 different countries, were consulted in an international workshop. Recommendations were validated with G-I-N PUBLIC steering committee members. Results Many CPG organisations have set up PPIPs that use a range of participation, consultation and communication methods. Current PPIPs aim to improve the quality and responsiveness of CPGs to public expectations and needs, or to foster individual healthcare decisions. Some organisations use structured involvement methods, including providing training for patient and public representatives. A number of financial, organisational and sociopolitical barriers limit patient and public involvement. The paucity of process and impact evaluations limits our current understanding of the conditions under which patient and public involvement is most likely to be effective. Conclusion Greater international collaboration and research are needed to strengthen existing knowledge, development and evaluation of patient and public involvement in CPG. [ABSTRACT FROM PUBLISHER]

Objectives This study presents results from an electronic survey among paediatric department employees, addressing employees' attitudes and use of results from a national parent experience survey carried out in 2005. Methods Electronic questionnaire survey of employees from each of the 20 paediatric departments included in the national survey, with a response rate of 87%. Results The employees had favourable opinions of user experience surveys, and the results from the national survey were well known among both managers and other personnel. User experience surveys were considered important, and 56% reported that they had implemented improvement actions addressing problems identified in the national survey. Managers reported more often than staff without managerial responsibility that the results had been informally discussed, and that the survey was useful for their own department. Department leaders were more positive to the usefulness of the survey than non-leaders. Significant differences in attitudes were found between physicians and other health personnel. Conclusion Employees in the paediatric departments were positive to user experience surveys, and the surveys have a potential to be actively used in quality improvement actions. Effects of the quality improvement initiatives should be assessed in future parent experience surveys. [ABSTRACT FROM PUBLISHER]

Objectives To assess chemotherapy patients' perceptions of safety and their attitudes towards participating in error-prevention strategies. Design Semistructured interviews were conducted with 30 chemotherapy patients at baseline. Follow-up interviews were conducted 9 weeks later. Setting A community hospital in Switzerland. Results Though patients had experienced errors in their care, they were only moderately worried about safety, risk of errors and the potential for harm. At follow-up, worries about safety had increased, and patients reported a higher degree of vigilance. Participants unequivocally agreed that patients can make contributions to their safety, and many patients were prepared to get involved. Patients described engaging in their safety as a learning process and highlighted the importance of being proactive, asking questions and communicating any observations of deviations from routines. Commonly recommended error-prevention strategies were rated as highly effective. Instruction by nurses was central for patients, but the underlying reasons varied. There was no indication that patients perceive participation in safety actions as eroding trust in their providers. Conclusions Patients are prepared to engage in their safety, but the encouragement by staff is vital. Involvement of patients with cancer in medication administration safety needs to acknowledge patients' conceptions of these activities and their varying abilities at different stages in the treatment process. [ABSTRACT FROM PUBLISHER]

Objective The authors examined the validity of documentation produced during paediatric emergency care to determine if a patient-driven health information technology called produced higher-quality data than documentation completed by nurses and physicians. Design The authors analysed the quality of information across elements of allergies to medications and the history of present illness (HPI) collected during a quasi-experimental intervention study where control periods with usual care alternated with intervention periods when was operational. Documentation by emergency department (ED) providers was abstracted and compared with information generated through . The criterion standard for the history of allergies to medications was a structured telephone interview with parents after the ED visit. A valid report for a medication allergy was one that was both accurate and complete. Completeness of the HPI for acute head trauma was evaluated across seven elements relevant to an evidence-based risk assessment. Results Of 1410 enrolled parents, 1111/1410 (79%) completed the criterion standard interview. Parents' valid reports of allergies to medications were higher than those of nurses (parents 94%, nurses 88%, p<0.0001). Parents' valid reports of allergies to medications were greater than those of physicians (parent 94%, physicians 83%, p<0.0001). produced more complete information on HPI for head trauma than the medical record for five of seven elements. Conclusion provided electronic information that met or exceeded the quality of data documented by ED nurses and physicians. [ABSTRACT FROM PUBLISHER]