Skip to main content

Abstract

In last three decades, several epidemiological studies have been developed in order to assess the magnitude, nature and type of adverse events (AEs). Most of these studies focus on hospital settings, where the activities are more standardised, but simultaneously more complex and involving higher risks.

However, in the last years, there is a growing movement and strong evidence that point out the importance of studying other healthcare contexts, such as primary care and long-term care. In Portugal, studies on primary care setting are scarce and still in the early stages.

In this article, the authors describe the AEs assessment in Portuguese Primary Health Care (PHC) units in Madeira Island/Portugal. This study was quantitative, cross-sectional, observational and analytical, with probability sampling. We quantify and analyse the AEs registered by healthcare providers using the APEAS-PT formulary.

A link to the APEAS–PT form was sent to 520 healthcare professionals (111 specialist in Family Medicine, 27 medical students, 382 nurses) who worked in 32 PHC centres. These professionals identified and analysed 85 AEs and 42 incidents, which corresponds to a prevalence of 3.9 AEs per 10,000 visits, with a 95% confidence interval (CI) between 3.7 and 4 AE. Most of the AEs were preventable (96%). The most frequent causal factors of AEs were associated with medication (69%), health care provided to users (54%), communication (41%) and diagnosis (22%).

This analysis of AEs in Madeira island PHC contributed to reinforce patient safety culture and to better understand quaternary prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Neto, J.A., Sirimarco, M.T., Figueiredo, N.S., Barbosa, T.N., Silveira, T.G.: Erro Médico - A perspectiva de estudantes de Medicina e Direito [The perspective of medical and law students]. Rev. Bras. Educ. Med. 35(1), 5–12 (2011)

    Article  Google Scholar 

  2. Kohn, L.T., Corrigan, J.M., Donaldson, M.S.: To Err is Human: Building a Safer Health System. National Academy Press, Washington, DC (2000)

    Google Scholar 

  3. Brennan, T.A., Leape, L.L., Laird, N.M., et al.: Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice study I. N. Engl. J. Med. 324(6), 370–376 (1991). https://doi.org/10.1056/NEJM199102073240604

    Article  Google Scholar 

  4. Mendes, C.M., Barroso, F.F.: Promover uma cultura de segurança em cuidados de saúde primários [Promote a culture of safety in Primary Health Care]. Rev Por Saúde Pública. 32(2), 197–205 (2014)

    Article  Google Scholar 

  5. Fragata, J., Martins, L.: O Erro em Medicina [The Mistake in Medicine]. Almedina, Coimbra (2009)

    Google Scholar 

  6. Sousa, P., Uva, A.S., Serranheira, F., Uva, M.S., Nunes, C.: Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retorspective cohort study. Int. J. Qual. Health Care, 1–6 (2018). https://doi.org/10.1093/intqhc/mzx190

    Article  Google Scholar 

  7. Granja, M., Ponte, C., Cavadas, L.: What keeps family physicians busy in Portugal? A multicentre observacional study of work other than direct patient contacts. BMJ Open 4, 1–11 (2014). https://doi.org/10.1136/bmjopen-2014005026

    Article  Google Scholar 

  8. Wetzels, R., Wolters, R., van Weel, C., Wensing, M.: Harm caused by adverse events in primary care: a clinical observational study. J. Eval. Clin. Pract. 15(2), 323–327 (2009). https://doi.org/10.1111/j.1365-2753.2008.01005.x

    Article  Google Scholar 

  9. Agencia de Calidad del Sistema Nacional de Salud. Estudio APEAS: Estudio Sobre La Seguridad de Los Pacientes en Atención Primaria de Salud. [APEAS Study: Study on the Safety of Patients in Primary Health Care]. Madrid (2008)

    Google Scholar 

  10. Makeham, M., Dovey, S., Runciman, W., Larizgoitia, I.: Methods and measures used inprimary care patient safety research: results of a literature review. World Heal Organ (2008)

    Google Scholar 

  11. Ribas, M.J.: Eventos adversos em cuidados de saúde primários: Promover uma cultura de segurança [Adverse events in Primary Health Care: promoting a culture of safety]. Rev Port Clin Geral. 26(Dossier: Erro Médico), 585–589 (2010)

    Google Scholar 

  12. Ornelas, M.D., Pais, D., Sousa, P.: Patient safety culture in Portuguese primary healthcare. Qual. Prim. Care. 24(5), 214–218 (2016)

    Google Scholar 

  13. Departamento da Qualidade na Saúde - DGS. Estrutura Concetual Da Classificação Internacional Sobre Segurança Do Doente [Conceptual Framework of the International Classification on Patient Safety]. Lisboa (2011)

    Google Scholar 

  14. Departamento da Qualidade na Saúde - DGS. Tipologia de Incidentes Notificados Top 3 - Profissional Top 3 - Cidadão [Typology of Notified Incidents Top 3 - Professional Top 3 - Citizen] (2015)

    Google Scholar 

  15. Elder, N.C., Pallerla, H., Regan, S.: What do family physicians consider an error? A comparison of definitions and physician perception. BMC Fam. Pract. 7, 73 (2006)

    Article  Google Scholar 

  16. McKay, J., Bowie, P., Murray, L., Lough, M.: Attitudes to the identification and reporting of significant events in general practice. Clin. Gov. An. Int. J. 9(2), 96–100 (2004)

    Article  Google Scholar 

  17. Tamuz, M., Thomas, E.J., Franchois, K.E.: Defining and classifying medical error: lessons for patient safety reporting systems. Qual. Saf. Heal. Care 13(1), 13–21 (2004)

    Article  Google Scholar 

  18. Hobgood, C., Xie, J., Weiner, B., Hooker, J.: Error identification, disclosure, and reporting: practice patterns of three emergency medicine provider types. Acad. Emerg. Med. 11(2), 196–199 (2004)

    Article  Google Scholar 

  19. Jeffe, D.B., Dunagan, W.C., Garbutt, J., et al.: Using focus groups to understand physicians’ and nurses’ perspectives on error reporting in hospitals. J. Qual. Saf. [Internet] 30(9), 471–9 (2004). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pub-Med&dopt=Citation&list_uids=15469124

  20. Dovey, S.M., Phillips, R.L.: What should we report to medical error reporting systems? Qual. Saf. Heal. Care 13(5), 322–323 (2004)

    Article  Google Scholar 

  21. Taylor, J.A., Brownstein, D., Christakis, D.A., et al.: Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics 114(3), 729–735 (2004)

    Article  Google Scholar 

  22. Karsh, B., Hamilton, K., Beasley, J.W., Holden, R.J.: Toward a theoretical approach to medical error reporting system research and design. Appl. Ergon. 37(3), 283–295 (2006)

    Article  Google Scholar 

  23. Elder, N.C., Graham, D., Brandt, E., Hickner, J.: Barriers and motivators for making error reports from family medicine offices: a report from the American Academy of Family Physicians National Research Network (AAFP NRN). J. Am. Board Fam. Med. [Internet], 20(2), 115–23 (2007). http://www.ncbi.nlm.nih.gov/pubmed/17341747

    Article  Google Scholar 

  24. Elder, N.C.: The identification of medical errors by family physicians during outpatient visits. Ann Fam Med. 2(2), 125–129 (2004). https://doi.org/10.1370/afm.16

    Article  Google Scholar 

  25. Rosser, W., Dovey, S., Bordman, R., White, D., Crighton, E., Drummond, N.: Medical errors in primary care: results of an international study of family practice. Can. Fam. Physician 51, 386–387 (2005)

    Google Scholar 

  26. Makeham, M.B., Dovey, S.M., County, M., Kidd, M.R.: An international taxonomy for errors in general practice: A pilot study. Med. J. Aust. 177(2), 68–72 (2002)

    Google Scholar 

  27. Westfall, J.M., Fernald, D.H., Staton, E.W., Vanvorst, R., West, D., Pace, W.D.: Applied strategies for improving patient safety: a comprehensive process to improve care in rural and frontier communities. J. Rural. Heal. 20(4), 355–362 (2004). https://doi.org/10.1111/j.1748-0361.2004.tb00049.x

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marta Dora Ornelas .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Ornelas, M.D., Sousa, P. (2019). Assessing Adverse Events in Madeira Primary Health Care. In: Cotrim, T., Serranheira, F., Sousa, P., Hignett, S., Albolino, S., Tartaglia, R. (eds) Health and Social Care Systems of the Future: Demographic Changes, Digital Age and Human Factors. HEPS 2019. Advances in Intelligent Systems and Computing, vol 1012. Springer, Cham. https://doi.org/10.1007/978-3-030-24067-7_23

Download citation

Publish with us

Policies and ethics