Emergency Medicine, Critical Care and Intensive Care Medicine
4
Scopus Publications
Scopus Publications
Avoidable adverse events related to ignoring the do-not-do recommendations: A retrospective cohort study conducted in the Spanish primary care setting José Joaquín Mira, Irene Carrillo, Pastora Pérez-Pérez, Maria Pilar Astier-Peña, Johanna Caro-Mendivelso, Guadalupe Olivera, Carmen Silvestre, Mª Angeles Nuín, Jesús M. Aranaz-Andrés, and Journal of Patient Safety, 2021 Objective This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care. Methods A retrospective cohort study analyzing the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed. Results A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval [CI], 71.0%–74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 [5.3%]; 95% CI, 4.1%–6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%–6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%–9.1%). In adult patients, the majority of AAEs (51/901 [5.7%]; 95% CI, 4.2%–7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 [51.9%]; 95% CI, 38.5%–65.2%) and pediatric patients (15/15 [100%]). Conclusions These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised. Trial Registration Number NCT03482232.
Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity Irene Carrillo, José Joaquín Mira, M. Pilar Astier-Peña, Pastora Pérez-Pérez, Johanna Caro-Mendivelso, Guadalupe Olivera, Carmen Silvestre, Aurora Mula, María Ángeles Nuin, Jesús M. Aranaz-Andrés, Ana Fernández, Javier González de Dios, Cristina Nebot, Julián Vitaller, Elena Caride Miana, Alberto Asencio Aznar, Vicente Rodríguez Sempere, María Isabel Hervella Durantez, Antonio Molina Santiago, Carmen María Hermida Carbonell, María Juan Andrés, María del Mar Bastante Romero, Blanca Puntes Felipe, Diego Pueyo Gascón, Marta Domínguez García, Daniel Ferrer Sorolla, Imma Hospital Guardiola, Eva Oya Girona, José Manuel López Suárez, Amalia Pinilla de Torre, Irene Centeno García, Bárbara Sanchez Pina, Ana Romero García, Tania María Cedeño Benavides, Irays Desireé Corro Castro, Esther Acosta Acosta, Javier Sánchez Holgado, Alba Marina Alfaro Hernández, Cristina Palacios Palomares Atencion Primaria, 2020 Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP). Estudio retrospectivo de cohortes. consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana. Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres. Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019. Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p = 0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos. Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto. To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC). Retrospective cohort study. Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia. A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients. Number and severity of identified AAEs from February 2018 to September 2019. A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients. Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
Real-life experience with Dulaglutide: Analysis of clinical effectiveness to 24 months Fernando Moreno Obregón, José Pablo Miramontes-González, Catalina Romo Guajardo-Fajardo, Ángel Nieto-Sánchez, José Manuel López-Suárez, Javier Martín-Vallejo, Yolanda Arco-Prados, María Dolores García de Lucas, David León-Jiménez Diabetes Research and Clinical Practice, 2019
An estimate of the cost of administering intravenous biological agents in Spanish day hospitals Joan Miquel Nolla, Esperanza Martin, Pilar Llamas, Javier Manero, Arturo Rodríguez de la Serna, Manuel Fernández-Miera, Mercedes Rodríguez, José Manuel López, Alexandra Ivanova, Belén Aragón Therapeutics and Clinical Risk Management, 2017 OBJECTIVE: To estimate the unit costs of administering intravenous (IV) biological agents in day hospitals (DHs) in the Spanish National Health System. PATIENTS AND METHODS: Data were obtained from 188 patients with rheumatoid arthritis, collected from nine DHs, receiving one of the following IV therapies: infliximab (n=48), rituximab (n=38), abatacept (n=41), or tocilizumab (n=61). The fieldwork was carried out between March 2013 and March 2014. The following three groups of costs were considered: 1) structural costs, 2) material costs, and 3) staff costs. Staff costs were considered a fixed cost and were estimated according to the DH theoretical level of activity, which includes, as well as personal care of each patient, the DH general activities (complete imputation method, CIM). In addition, an alternative calculation was performed, in which the staff costs were considered a variable cost imputed according to the time spent on direct care (partial imputation method, PIM). All costs were expressed in euros for the reference year 2014. RESULTS: The average total cost was €146.12 per infusion (standard deviation [SD] ±87.11; CIM) and €29.70 per infusion (SD ±11.42; PIM). The structure-related costs per infusion varied between €2.23 and €62.35 per patient and DH; the cost of consumables oscillated between €3.48 and €20.34 per patient and DH. In terms of the care process, the average difference between the shortest and the longest time taken by different hospitals to administer an IV biological therapy was 113 minutes. CONCLUSION: The average total cost of infusion was less than that normally used in models of economic evaluation coming from secondary sources. This cost is even less when the staff costs are imputed according to the PIM. A high degree of variability was observed between different DHs in the cost of the consumables, in the structure-related costs, and in those of the care process.
