Journal of evaluation in clinical practice
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Building a strong and positive safety culture in health care teams and organizations is essential for patient safety. Measuring individual perceptions of safety climate is an integral part of this process. Evidence of the successful application and potential usefulness of this approach is increasingly available for secondary care settings but little is known about the safety climate in UK primary care. We therefore aimed to measure perceptions of safety climate in primary care. Further aims were to determine whether perceptions varied significantly between practice teams and according to specific participant and practice characteristics. ⋯ This was the first known attempt to measure perceptions of safety climate in UK primary care with a validated instrument specifically developed for that purpose. Reported perceptions of the prevailing safety climate were generally positive. This may reflect ongoing efforts to build a strong safety culture in primary care or alternatively point to an overestimation of the effectiveness of local safety systems. The significant variation in perception between certain staff groups has potential safety implications and may have to be aligned for a positive and strong safety culture to be built. While safety climate measurement has various benefits at the individual, practice team and regional level, further research of its association with specific safety outcomes is required.
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In 2002, the US Preventive Services Task Force recommended routine osteoporosis screening for women aged 65 years or older. However, studies have indicated that osteoporosis remains underdiagnosed, and various methods such as the use of health information technology have been tried to increase screening rates. We investigated whether we could boost the low rates of bone mineral density testing with implementation of a point-of-care clinical decision support system in our primary care practice. ⋯ Clinical decision support for primary care doctors significantly improved osteoporosis screening rates among eligible women. Carefully designed clinical decision support systems can optimize care delivery, ensuring that important preventive services such as osteoporosis screening for patients at risk for fracture are performed while unnecessary testing is avoided.
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Diagnostic reasoning is a critical aspect of clinical performance, having a high impact on quality and safety of care. Although diagnosis is fundamental in medicine, we still have a poor understanding of the factors that determine its course. According to traditional understanding, all information used in diagnostic reasoning is objective and logically driven. However, these conditions are not always met. Although we would be less likely to make an inaccurate diagnosis when following rational decision making, as described by normative models, the real diagnostic process works in a different way. Recent work has described the major cognitive biases in medicine as well as a number of strategies for reducing them, collectively called debiasing techniques. However, advances have encountered obstacles in achieving implementation into clinical practice. ⋯ Using a cognitive approach, we describe the basis of medical error, with particular emphasis on diagnostic error. We then propose a conceptual scheme of the diagnostic process by the use of fuzzy cognitive maps.
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Minor Illness and Injury Units (MIUs) are becoming a key element in the Urgent Care strategies of Primary Care Trusts. They are intended to both improve access to primary care and to reduce the workload of hospital emergency departments. Their efficiency in resolving patients' needs for health care has been questioned. We sought to describe subsequent health care utilisation among people attending two MIUs in Sunderland, UK. ⋯ Although most people attending Minor Illness and Injury Units are treated and discharged, subsequent use of health care services is common and in a third of cases is unscheduled. This calls into question the effectiveness of MIUs as an alternative to general practice but may reflect a need for better signposting of patients to the service best suited to their needs.
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Most mental health outcome and satisfaction measures have been developed by academic researchers or service providers. Consumers have been limited to the role of participant or advisor. The validity and reliability of these satisfaction measures have been challenged. This paper reports the development of a consumer satisfaction questionnaire in which consumers work as collaborative researchers to increase its face validity and relevance. ⋯ The questionnaire was developed in accordance with an evaluation framework of consumer directed evaluation of mental health services. The final questionnaire consists of 26 items. It has satisfactory internal consistency and appeared to be useful with inpatients and outpatients. Further research will be performed to establish its test-retest reliability and criterion validity.