1. Future research perspectives on Patient Safety in Primary Care: The View from Australasia Susan Dovey University of Otago Dunedin, New Zealand

5. Summary A brief history of Primary Care Patient Safety research in Australasia What we’re up to now Where I think we are going

6. Timeline of key publications 1981 - Inman W. Postmarketing surveillance of adverse drug reactions in general practice. I: search for new methods. Br Med J (Clin Res Ed) 1981; 282(6270): 1131-2 1992 - Neu H. The Crisis in Antibiotic Resistance Science 1992; 257(5073): 1064-73 1993 - Greco P,Eisenberg J. Changing physicians’ practice. N Engl J Med 1993; 329: 1271-4. 1994 - TorelloLserte J, Ferrando JC, Lainez M, Morillas MG, Gonzalez AA. [Adverse reactions to drugs reported by the primary care physicians of Andalusia. Analysis of underreporting]. Atencion Primaria 1994; 13(6): 307-11 1995 - Diamond M, Kamien M, Sim M, Davis J. A critical incident study of general practice trainees in their basic general practice term. Med J Aust 1995; 162(6): 321-4. 1995 - Ely J, Levinson W, Elder N, Mainous A, Vinson D. Perceived causes of family physicians’ errors. J Fam Pract 1995; 40(4): 337-44 1997 - Britt H et al. Collecting data on potentially harmful events: A method for monitoring incidents in general practice. Fam Pract 1997; 14(2): 101-6. 1997 - Fischer G, Fetters M, Munro A, Goldman E. Adverse events in primary care identified from a risk-management database. J Fam Pract 1997; 45(1): 40-6

7. Timeline cont. 1999 - Kohn L, Corrigan J, Donaldson M, eds. To Err Is Human: Building a Safer Health System. 1999, National Academy Press: Washington DC 2000 - An organisation with a memory: Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer. 2000, London: The Stationery Office 2001 - MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupuncture Med 2001; 19(2): 93-102. Acupuncture Med 2001; 19(2): 93-102. 2002 - Dovey S, Meyers D, Phillips R, Green L, et al. A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care 2002; 11(3): 233-8 2002 - Makeham M, Dovey S, County M, Kidd M. An international taxonomy for reporting general practice error in Australia and five other countries. Med J Aust 2002; 177: 68-72

8. What we are up to now: Primary Care Patient Safety publications 2011-12

12. New foci for Patient Safety Infrastructure Standards Protocols

13. What I am up to now: A general practice records review study 1.To estimate the incidence of adverse events in general practice 2.To estimate the incidence of preventable adverse events in general practice 3.To estimate the degree of harm arising from adverse events in general practice 4.To do all the above using the methods of the hospital-based patient safety studies

14. Effectiveness of general practice accreditation in enhancing quality 1.Collaborating with McMaster, Canada, where there is no practice accreditation process 2.Part ecological – has it worked in New Zealand? 3.Part investigative – does it work in Canada?

15. Where we are going in patient safety research in Australasia International health systems comparative research: what regulatory, cultural, historical, political factors make one country’s health system safer than another? Epidemiology of safety events by sentinel event reporting Epidemiology of safety events by retrospective records review – maybe Epidemiology of safety events by other methods (direct observation, new methods) - maybe

16. Drug studies ▫Measuring harm from drug use ▫Measuring harm from withholding drug use ▫RCTs of drugs to establish safety and efficacy ▫Pharmacovigilance studies to detect signals in population databases Tomlin A, Reith D, Dovey S, Tilyard M. Methods for retrospective detection of drug safety signals and adverse events in electronic general practice records. Drug Safety 2012; 35(9): 733-43

17. Safety culture ▫Tools to change safety culture in practices ▫Tools to change safety culture in medical schools ▫Tools to engage patients in protecting their safety Diagnosis ▫Safety and efficacy of diagnosis decision aids

18. Safety education ▫Undergraduate medical curriculum ▫Simulation clinics

21. Today’s Agenda 1.Review what you are being asked to do 2.Start on definitions 3.Try them out on data 4.Update on Trigger Tool

22. This is what the study needs of you

23. Your job: the ultimate decision Andy and I review records We think we see an adverse event We batch up 5 (10?) and you get an email You log onto the VRE and review to decide AE (Y/N); preventable (Y/N); severity Your form is completed and back to us

24. 2 Reviewers; 48-50 suspected Adverse Events; 10 pairs Martyn and Wayne Martyn and Steven L Martyn and Katharine Martyn and Murray Katharine and Wayne Katharine and Steven L Katharine and Murray Murray and Steven L Murray and Wayne Wayne and Steven L

25. Other specific jobs Wayne = 1 st port of call for clinical questions David Reith = 1 st port of call for drug questions Steven Buetow = running a Delphi study to confirm definitions

26. Definitions

27. Try these definitions on real data

28. The Trigger Tool and what Andy’s been up to