Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.
Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.
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DOI：
10.1136/bmjopen-2016-013524
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发表时间：
2017-05-30
期刊：
影响因子：
2.9
通讯作者：
Bower P
中科院分区：
文献类型：
--
作者：
Panagioti M;Blakeman T;Hann M;Bower P
越来越多的证据表明，患者安全是长期病情的老年患者的一个严重问题。尽管如此，缺乏对这一患者群体遇到的安全事件的研究。在本研究中，我们试图检查患者的安全事件报告以及与患有长期疾病的老年患者的安全事件报告相关的因素。分析了纵向队列研究的基线横断面数据。本研究纳入了在全科诊所登记的患有长期疾病的老年患者（n=3378例，65岁及以上）。主要结局是患者报告的安全事件，包括医学检查的可用性和适当性以及错误类型或剂量的药物处方。进行二元单变量和多变量逻辑回归分析，以检查与患者报告的安全性事件相关的因素。11%的患者报告了安全事件。在多变量分析中，四个因素与患者报告的安全事件显著相关。多种长期疾病的经历（OR=1.09，95% CI 1.05 - 1.13）、抑郁症的可能诊断（OR=1.36，95% CI 1.06 - 1.74）和更大的相关护理连续性（OR=1.28，95% CI 1.08 - 1.52）与患者报告的安全性事件的几率增加相关。在自我管理中获得更多的支持和参与与患者报告的安全事件的几率较低相关（OR=0.95，95%CI 0.93至0.97）。我们发现，患有多发性硬化症和抑郁症的老年患者更有可能报告患者安全事件的经历。改善患者在护理中的感知支持和参与可能有助于防止患者报告的安全事件。
Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
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