Supervision of General Practitioners Practises

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Presentation transcript:

Supervision of General Practitioners Practises Openness about malfunctioning in medical practice 17-11-2018 Supervision of General Practitioners Practises 5.7.2017 Charlotte Hjort Head of one TR department, MD, PhD, MPG Danish Patient Safety Authority

Denmark – few facts Population: 5.75 million 3421 GP´s Wanted (1600 pt.) 3593 Lack of GP´s approx. 175 42,924 square kilometres 17. november 2018

Openness about malfunctioning in medical practice How 17-11-2018 Supervision at GP´s 2017 How 17. november 2018

Selection of theme Adverse events - statistics In lack of other data, we asked: our own employees our Strategic Board with representatives from Patient organisations Doctors, dentists and nurses organisations Danish Regions Local Government Denmark For 2017: Medication and test results in transitions (of patient flow) 17. november 2018

Selection of clinics From journals from our hospital supervision (random selection) From list of claims – whether or not criticism was given (risk based) From list of prescription habits (risk based) - opioids - benzodiazepins In 2017: Approx. 250 clinics 17. november 2018

Indicators – review of patient record Indication of examination and treatment Informed consent Decision of lifeprolonging treatment Discharge summary Following clinical guidelines of lung dissease (COLD) Following clinical guidelines of depression (suicide) 17. november 2018

Indicators – interview of doctors and staff Delegation of medication and vaccination Handling of anaphylaxis Prescription - iteration Review of patients medication Use of written instructions Prescription habits concerning addictive medicine Handling of test results from paraclinic investigations Instruction of the staff – in general and for specific procedures Hygiene 17. november 2018

Indicators - observation Outdated medicine Outdated sterilized products Hygiene In general Instruments Equipment Clinic rooms 17. november 2018

Supervisory team Two doctors Or One doctor and one nurse One doctor alone 17. november 2018

The supervisory visit Beforehand: Two instructions send beforehand – delegation and paraclinic) Out there: Introduction and setting the scene Interview Review of patient records Termination – what have we found – no conclusion Afterwards: Report – obligation to publis 17. november 2018

Openness about malfunctioning in medical practice What do we find? 17-11-2018 Supervision at GP´s 2017 What do we find? 17. november 2018

Until now: Visited 23 GP´s No statistics yet We have seen many good things We have seen same general problems in all clinics We have seen specific problems in some clinics 17. november 2018

Written consent Some GP´s do not agree in the necessity of writing this in the patient record We have talked about the treatment – the patient know what to do We do not have time for it The important informations is hidden by all the unnecessary things Then we just put a standard phrase in – the secretary can do so 17. november 2018

Medication Some GP´s do not agree in the legal order of prescription of addictive medicine We do not have time to see patients evry time they need an iteration of the prescription The cost of seeing all these patients so often is too high If the patient have endured the medication for 2 years then we can control it once a year 17. november 2018

Following guidelines Some GP´s do not agree in the correctness of guidelines In primary care evry patient is unique and do not fit to the guidelines Guidelines are just guiding – I know better Guidelines are made far away from daily practice I do not have time to follow the guideline 17. november 2018

Openness about malfunctioning in medical practice Dilemmas 17-11-2018 Supervision at GP´s 2017 Dilemmas 17. november 2018

Following guidelines Same shortcoming in two GP´s – trust/no trust Same number of un-fullfilled indicators – big difference Our focus – maybe sometimes hide more important issues Our selection – how to find ”the red ones” 17. november 2018

Thank you for your attention! 17. november 2018