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Table 1 Characteristics of the selected studies in the systematic review (studies categorized by themes)

From: Patient safety and safety culture in primary health care: a systematic review

Author and year

Title

Study design

Study Results and significant conclusions

Quality assessments

Safety Culture in primary care setting

 Kirk S [26] 2007

Patient safety culture in primary care; developing a theoretical framework for practical use.

Literature review followed by semi-structured interviews.

Study details development of the Manchester Patient Safety Framework

 

 Bodur S [8] 2009

A survey on patient safety in primary healthcare services in Turkey

Cross sectional study

Hospital survey on patient safety survey was adapted with modification to fit the Turkish primary care context. Positive responses were highest for teamwork within the units (76%) and lowest for events reporting (59%) and non-punitive response to errors (18%). Health center administrator must focus on improving patient safety culture and encourage staff to report errors without fear.

All items of STROBE statement covered

 Dorien LM Zwart [22] 2011

Patient safety culture measurement in general practice. Clinimetric properties of ‘SCOPE’

Descriptive Cross sectional study

88.8% completed the questionnaire, out of which 25% were GPs, 60% medical administrative assistants and 15% nurses. SCOPE seems a suitable tool to measure safety culture in general practice

All items of STROBE statement covered

Nargis T [7] 2012

The first study of patient safety culture in the Iranian primary health care.

Cross sectional study

Teamwork across the units scored the highest 77.7%, continuous organization learning scored 72% and the lowest was non-punitive response to error 17%.

All items of STROBE statement covered

Jacobs L [27] 2012

Creating a culture of patient safety in primary care physicians group.

Proactive approach Case study

Study based on adaptation of medical risk management strategy to help create a culture of safety in primary care. This led to reduction of malpractice claims and enhanced learning experience among physicians.

All items of STROBE statement covered

 Benjamin H [20] 2012

Better medical office safety culture is not associated with better scores on quality measures.

Cross section study

Response rate was 79%, significate variations on safety culture scores and quality scores. There was no association between safety culture and quality outcome measures.

All items of STROBE statement covered

 Yahia M [21] 2013

Attitude of primary care physicians toward safety in Aseer region, Saudi Arabia

Cross sectional study

Highest score was given to reduction of medical errors (6.2 points). Followed by training and learning on patient safety (6 and 5.9). Undergraduate training was given the least score and participants did not agree that errors were due to nurses or doctor’s carelessness.

All items of STROBE statement covered

 Lucine M [29] 2013

Is health professional’s perception of patient safety related to figures on safety incidents?

Retrospective Observational study

Communication breakdown inside or outside the practice are threats to patient safety. The study indicates that assessments of professional’s perception are complementary to observed safety incidents.

All items of STROBE statement covered

 Fernando P [18] 2013

Patient safety culture in primary health care.

Cross sectional study

Working conditions, teamwork climate, communication and management of healthcare were significate with patient safety culture.

All items of STROBE statement covered

 Maha G [10] 2014

Assessment of patient safety culture in primary health care setting in Kuwait.

Cross sectional studies

Hospital survey on patient safety survey was adapted with modification to fit the Kuwaiti primary care context. Dimensions with low positivity were: the non-punitive response to errors, frequency to error reporting, staffing, communication openness and center handoffs. High positivity was teamwork within the unit and organizational learning. Overall the safety culture is not strong in Kuwait.

All items of STROBE statement covered

 Natasha J [24] 2014

Improving patient safety in primary care: a systematic review.

Systematic review

2 articles selected which provide basic understanding of improvement strategies in primary care, low level of evidence

9/11 using AMSTAR

 Hoffmann B [25] 2014

Effects of a team based assessment and intervention on patient safety culture in general practice: an open randomized controlled trail.

Randomized control trail

FraTrix, which was derived from MaPSaf, was applied over a period of 9 months in the intervention practice. Fratrix didn’t lead to measurable improvements in error managements but lead to better reporting of patient safety incidents.

(EPHPP Statement used for assessment)

A strong study which highlighted limitations and implications.

 Palacios D [23] 2010

Dimensions of patient safety culture in family practice.

Qualitative case study

Explores the dimensions of patient safety culture related to family practice in UK, USA and Canada.

Global rating of this paper was moderate (Effective Public Health Practice Project)

Incident reporting in primary care setting

 Douglas H [35] 2004

Event reporting to a primary care patient safety reporting system: A report from the ASIPS collaborative.

Incident report analysis

Highest number of events was reported due to communication errors 71% followed by diagnostic and medication errors. A safe reporting system, which relies on voluntary reporting, can be adapted in primary care settings.

All items of STROBE statement covered

 Singh R [34] 2006

“Chance favors only the prepared mind”. Preparing minds to systematically reduce hazards in the testing process in primary care.

Prospective study

A proposed approach called as systematic appraisal of risk and its management for error reduction for test process (SARAIMER) was used. Successfully used in medication safety in primary care.

All items of STROBE statement covered

 Makeham M [33] 2007

Patient safety events reported in general practice: taxonomy.

Taxonomy

The outline taxonomy of events in general practice provides a complete tool for clinicians describing threats to patient safety and can build an error reporting system.

All items of STROBE statement covered

 Marleen S [38] 2010

Patient safety in out-of- hour’s primary care: a review of patient records.

Retrospective

Most frequent incidents occur in out-of- hours primary care were incidents on treatment (56%). Incidents did not result in patient harm. Improved understanding in clinical reason and adherence to guidelines will enhance patient safety.

All items of STROBE statement covered

 Zwart D [6] 2011

Central or local incident reporting? A comparative study in Dutch GP out of hour’s services.

Quasi experimental study

Local incident reporting facilitates the willingness to report and faster implementation of improvements. In contrast, central reporting seems better at addressing generic and recurring safety issues. Both approaches should be combined.

All items of STROBE statement covered

 Dorien LM Zwart [37] 2011

Feasibility of center-based incident reporting in primary healthcare: The SPIEGEL study

Prospective Observational study

476 incidents reported in 9 months, 62% incidents reported in the reporting week and majority were process oriented. All involved centers initiated improvement strategies due to reported incidents. Locally implemented incident reporting procedure as a tool for managing patient safety is feasible in general practice.

All items of STROBE statement covered

 Zwart D [36] 2013

Introducing incident reporting in primary care: a translation from safety science into medical practice

Prospective Observational study

The aim of the study was to understand and describe particular ways primary care physicians make incident reporting procedure part of dealing with safety issues.

All items of STROBE statement covered

 Marchon SG [39] 2014

Patient safety in primary health care: a systematic review.

Systematic review

33 articles were selected from 2007 to 2012: 26% on retrospective studies, 44% prospective studies. Frequent method used was incident reporting system 45% and the most relevant contributing factor was communication failure.

8/11 using AMSTAR

Safety climate in primary care setting

 Hoffmann B [35] 2011

The Frankfurt patient safety climate questionnaire for general practice (FraSik): analysis of psychometric properties.

Cross sectional studies

Questionnaire was modified in order to be applicable for general practice. The tool can be used for assessment of the safety climate of general practice.

All items of STROBE statement covered

 De Wet C [37] 2012

Measuring perception of safety climate in primary care: a cross- sectional study.

Cross sectional study

Perception of safety climate in the UK primary care with a validated tool specifically designed for it. Measuring safety climate has various benefits at the individual, practice and regional level.

All items of STROBE statement covered

 Hoffmann B [36] 2013

Impact of individual and team features of patient safety climate: A survey in family practice.

Cross section studies

FraSik was used to identify potential predictors of the safety climate in family practice in Germany. The overall climate was positive but the health professional’s use of incident reporting and systems approach to errors was fairly rare.

All items of STROBE statement covered

Adverse events in primary care setting

 Sweidan M [41] 2010

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process.

Modified Delphi process.

114 software features were developed which relate to recording and use of patient data, the medication selection process, prescribing decision-making support, monitoring drug therapy and clinical reports. This feature supports safety and quality of prescription of medication in general practice.

Modified Delphi process.

 Wong K [40] 2010

A systematic review of medication safety outcomes related to drug interaction software.

Systematic review

No study addressed the benefits and harms or cost effectiveness of drug interactions. The evidence does not support a benefit of software on medication safety or support any practice in this policy.

7/11 using AMSTAR

 Singh R [42] 2004

Estimation impacts on safety caused by the introduction of the electronic medical records in primary care.

FMEA

Hazard score was calculated for each error before and 1 year after implementation of electronic medical records. Hazards perceived by staffs decreased in domains of physician –nurses and physicians –chart. But increase in physician- patient and nurse- chart domain.

All items of STROBE statement covered

 Joachim S [43] 2011

Effectiveness of a quality improvement program in improving management of primary care practices

Cross sectional study

Primary care practices that completed the European Practice assessments twice over a period of 3 yrs showed overall improvements in practice management, quality and safety and complaint management.

All items of STROBE statement covered