PMID- 37043330
OWN - NLM
STAT- MEDLINE
DCOM- 20230501
LR  - 20230525
IS  - 1464-3677 (Electronic)
IS  - 1353-4505 (Print)
IS  - 1353-4505 (Linking)
VI  - 35
IP  - 2
DP  - 2023 Apr 29
TI  - Is primary care a patient-safe setting? Prevalence, severity, nature, and causes 
      of adverse events: numerous and mostly avoidable.
LID - 10.1093/intqhc/mzad019 [doi]
LID - mzad019
AB  - 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.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of 
      International Society for Quality in Health Care.
FAU - Garzon Gonzalez, Gerardo
AU  - Garzon Gonzalez G
AUID- ORCID: 0000-0001-9212-1608
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Alonso Safont, Tamara
AU  - Alonso Safont T
AD  - Information Systems Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Zamarron Fraile, Ester
AU  - Zamarron Fraile E
AD  - 'Baviera' Primary Healthcare Centre (Centro de Salud Baviera), Primary Care 
      Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service 
      (SERMAS), C/ PIntor Moreno Carbonero 21, Madrid 28028, Spain.
FAU - Canada Dorado, Asuncion
AU  - Canada Dorado A
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Luaces Gayan, Arancha
AU  - Luaces Gayan A
AD  - 'Torrelodones' Primary Healthcare Centre (Centro de Salud Torrelodones), Primary 
      Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health 
      Service (SERMAS), 28250 Torrelodones, Madrid, Spain.
FAU - Conejos Miquel, Dolores
AU  - Conejos Miquel D
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Villanueva Sanz, Cristina
AU  - Villanueva Sanz C
AD  - 'Vicente Muzas' Primary Healthcare Centre (Centro de Salud Vicente Muzas), 
      Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid 
      Health Service (SERMAS), C/ Vicente Muzas 8, Madrid 28043, Spain.
FAU - Aguado Arroyo, Oscar
AU  - Aguado Arroyo O
AD  - 'Francia' Primary Healthcare Centre (Centro de Salud Francia), Primary Care 
      Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service 
      (SERMAS), 28943 Fuenlabrada, Madrid, Spain.
FAU - Jurado Balbuena, Juan Jose
AU  - Jurado Balbuena JJ
AD  - 'Alicante' Primary Healthcare Centre (Centro de Salud Alicante), Primary Care 
      Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service 
      (SERMAS), 28945 Fuenlabrada, Madrid, Spain.
FAU - Castelo Jurado, Marta
AU  - Castelo Jurado M
AD  - 'Federica Montseny' Primary Healthcare Centre (Centro de Salud Federica 
      Montseny), Primary Care Management (Gerencia Asistencial de Atencion Primaria), 
      Madrid Health Service (SERMAS), Av Albufera 285, Madrid 28038, Spain.
FAU - Magan Tapia, Purificacion
AU  - Magan Tapia P
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Barbera Martin, Aurora
AU  - Barbera Martin A
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
FAU - Toribio Vicente, Maria Jose
AU  - Toribio Vicente MJ
AD  - Admission Unit, 'Gregorio Maranon' University General Hospital (Hospital General 
      Universitario Gregorio Maranon), Madrid Health Service (SERMAS), C/ Doctor 
      Esquerdo 46, Madrid 28009, Spain.
FAU - Drake Canela, Mercedes
AU  - Drake Canela M
AD  - Quality Unit, 'Infanta Leonor' University Hospital (Hospital Universitario 
      Infanta Leonor), Madrid Health Service (SERMAS), AV Gran V'ia Este 80, Madrid 
      28031, Spain.
FAU - San Jose Saras, Diego
AU  - San Jose Saras D
AD  - Preventive Medicine Service, 'Ramon y Cajal' University Hospital (Hospital 
      Universitario Ramon y Cajal), Madrid Health Service (SERMAS), M 607 9.100, Madrid 
      28034, Spain.
FAU - Mediavilla Herrera, Inmaculada
AU  - Mediavilla Herrera I
AD  - Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de 
      Atencion Primaria), Madrid Health Service (SERMAS), C/ San Martin de Porres 6, 5 feminine 
      planta, Madrid 28035, Spain.
LA  - eng
GR  - PI20/01012/European Regional Development Fund/
GR  - PI20/01012/Instituto de Salud Carlos III/
PT  - Journal Article
PL  - England
TA  - Int J Qual Health Care
JT  - International journal for quality in health care : journal of the International 
      Society for Quality in Health Care
JID - 9434628
SB  - IM
EIN - Int J Qual Health Care. 2023 May 25;35(2):. PMID: 37227934
MH  - Humans
MH  - Female
MH  - Adolescent
MH  - Adult
MH  - *Medical Errors/prevention & control
MH  - Prevalence
MH  - Cross-Sectional Studies
MH  - Risk Factors
MH  - *Primary Health Care
PMC - PMC10148678
OTO - NOTNLM
OT  - medical errors
OT  - patient harm
OT  - patient safety
OT  - prevalence
OT  - primary health care
OT  - 'adverse events'
EDAT- 2023/04/13 06:00
MHDA- 2023/05/01 06:41
PMCR- 2023/04/12
CRDT- 2023/04/12 12:23
PHST- 2022/08/04 00:00 [received]
PHST- 2023/01/10 00:00 [revised]
PHST- 2023/04/11 00:00 [accepted]
PHST- 2023/05/01 06:41 [medline]
PHST- 2023/04/13 06:00 [pubmed]
PHST- 2023/04/12 12:23 [entrez]
PHST- 2023/04/12 00:00 [pmc-release]
AID - 7116073 [pii]
AID - mzad019 [pii]
AID - 10.1093/intqhc/mzad019 [doi]
PST - ppublish
SO  - Int J Qual Health Care. 2023 Apr 29;35(2):mzad019. doi: 10.1093/intqhc/mzad019.