Qual Saf Health Care
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Qual Saf Health Care · Dec 2007
Comparative StudyDifferences in the quality of primary medical care services by remoteness from urban settlements.
To examine if the quality of primary medical care varies with remoteness from urban settlements. ⋯ Under QOF, there are few differences in the quality of care delivered to patients in practices with different degrees of remoteness. The differences in achievement for cholesterol were consistent with lower rates of statin prescribing relative to disease burden in very remote practices. No differences were found for complex process measures such as retinopathy screening, implying that differences under QOF are more likely to be due to slower adoption of evidence-based practice than access problems. Examining this will require analysis of individual patient data.
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Qual Saf Health Care · Dec 2007
Capturing users' experience of UK out-of-hours primary medical care: piloting and psychometric properties of the Out-of-hours Patient Questionnaire.
Provision of out-of-hours care in the UK National Health Service (NHS) has changed in recent years with new models of provision and the introduction of national quality requirements. Existing survey instruments tend to focus on users' satisfaction with service provision; most were developed without undertaking supporting qualitative fieldwork. In this study, a survey instrument was developed taking account of these changes in service provision and undertaking supporting qualitative fieldwork. This paper reports on the development and psychometric properties of the new survey instrument, the Out-of-hours Patient Questionnaire (OPQ), which aims to capture information on the entirety of users' experiences of out-of-hours care, from the decision to make contact through to completion of their care management. ⋯ The OPQ is an acceptable instrument for capturing information on users' experiences of out-of-hours care. Preliminary evidence suggests it is both valid and reliable in use. Further work will report on its utility in informing out-of-hours service planning and configuration and standard-setting in relation to UK national quality requirements.
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Qual Saf Health Care · Dec 2007
Exploring users' experiences of accessing out-of-hours primary medical care services.
Since 2000, out-of-hours primary medical care services in the UK have undergone major changes in the organisation and delivery of services in response to recommendations by the Carson Review and more recently, through the new General Medical Services Contract (GMS2). People calling their general practice in the evening or at weekends are redirected to the out-of-hours service which may offer telephone advice, a home visit or a visit to a treatment centre. Little is known about users' experiences under the new arrangements. ⋯ Service users need clear information on how current out-of-hours services operate and how it should be used. Problems with triaging need to be addressed, users should be kept informed of any delays, and care needs to be taken to ensure that the new arrangements do not alienate older people or individuals with complex health needs.
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Qual Saf Health Care · Dec 2007
Comparative StudyComparison of patients' assessments of the quality of stroke care with audit findings.
To determine the extent of correlation between stroke patients' experiences of hospital care with the quality of services assessed in a national audit. ⋯ Better organised stroke care is associated with more positive patient experiences. Examining areas of disparity between patients' and clinicians' reports is important for understanding the complex nature of healthcare and for identifying areas for quality improvement. Future evaluations of the quality of stroke services should include a validated patient experience survey in addition to audit of clinical records.
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Qual Saf Health Care · Oct 2007
French national survey of inpatient adverse events prospectively assessed with ward staff.
To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors. ⋯ At the national level in France, every year 120,000-190,000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence-based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritize empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for ward-level identification and analysis of adverse events.