Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study
| Autor: | Ariyapala Samaranayaka, Sharon Leitch, David M. Reith, Wayne Cunningham, Murray Tilyard, Andrew W. McMenamin, Susan Dovey, Katharine Wallis, Martyn Williamson, Kyle Eggleton, Steven Lillis |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
General Practice quality in health care health & safety 03 medical and health sciences Patient safety primary care 0302 clinical medicine Intervention (counseling) Epidemiology Health care medicine Humans 030212 general & internal medicine Retrospective Studies business.industry 030503 health policy & services Incidence (epidemiology) Retrospective cohort study General Medicine Stratified sampling Harm Family medicine Medicine 0305 other medical science business General practice / Family practice Family Practice Delivery of Health Care New Zealand |
| Zdroj: | BMJ Open, Vol 11, Iss 7 (2021) BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesTo determine the epidemiology of healthcare harm observable in general practice records.DesignRetrospective cohort records review study.Setting72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by rurality and size; 44 clinics consented to participate.Participants9076 patient records were randomly selected from participating clinics.InterventionEight general practitioners examined patient records (2011–2013) to identify harms, harm severity and preventability. Analyses were weighted to account for the stratified sampling design and generalise findings to all New Zealand patients.Main outcome measuresHealthcare harm, severity and preventability.ResultsReviewers identified 2972 harms affecting 1505 patients aged 0–102 years. Most patients (82.0%, weighted) experienced no harm. The estimated incidence of harm was 123 per 1000 patient-years. Most harms (2160; 72.7%, 72.4% weighted) were minor, 661 (22.2%, 22.8% weighted) were moderate, and 135 (4.5%, 4.4% weighted) severe. Eleven patients died, five following a preventable harm. Of the non-fatal harms, 2411 (81.6%, 79.4% weighted) were considered not preventable. Increasing age and number of consultations were associated with increased odds of harm. Compared with patients aged ≤49 years, patients aged 50–69 had an OR of 1.77 (95% CI 1.61 to 1.94), ≥70 years OR 3.23 (95% CI 2.37 to 4.41). Compared with patients with ≤3 consultations, patients with 4–12 consultations had an OR of 7.14 (95% CI 5.21 to 9.79); ≥13 consultations OR 30.06 (95% CI 21.70 to 41.63).ConclusionsStrategic balancing of healthcare risks and benefits may improve patient safety but will not necessarily eliminate harms, which often arise from standard care. Reducing harms considered ‘not preventable’ remains a laudable challenge. |
| Databáze: | OpenAIRE |
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