Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review.

BACKGROUND: Considered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children. METHOD: A systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF). RESULTS: A total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity. CONCLUSION: This systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system's organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children's access to caries prevention. TRIAL REGISTRATION: PROSPERO CRD42022304545.

Improving patient self-reporting of antihypertensive adverse drug events in primary care: a stepped wedge cluster randomised trial.

BACKGROUND: About 25% of patients experience adverse drug events (ADE) in primary care, but few events are reported by the patients themselves. One solution to improve the detection and management of ADEs in primary care is for patients to report them to their general practitioner. The study aimed to assess the effect of a booklet designed to improve communication and interaction between patients treated with anti-hypertensive drugs and general practitioners on the reporting of ADEs. METHODS: A cluster randomized controlled cross-sectional stepped wedge open trial (five periods of 3 months) was conducted. A cluster was a group of general practitioners working in ambulatory offices in France. Adults consulting their general practitioner to initiate, modify, or renew an antihypertensive prescription were included. A booklet including information on cardiovascular risks, antihypertensive treatments, and ADE report forms was delivered by the general practitioner to the patient in the intervention group. The primary outcome was the reporting of at least one ADE by the patient to his general practitioner during the three-month period after enrolment. Two clusters were randomised by sequence for a total of 8 to receive the intervention. An intention-to-treat analysis was conducted. A logistic mixed model with random intercept was used. RESULTS: Sixty general practitioners included 1095 patients (median: 14 per general practitioner; range: 1-103). More patients reported at least one ADE to their general practitioner in the intervention condition compared to the control condition (aOR = 3.5, IC95 [1.2-10.1], p = 0.02). The modification and initiation of an antihypertensive treatment were also significantly associated with the reporting of ADEs (aOR = 4.4, CI95 [1.9-10.0], p <  0.001 and aOR = 11.0, CI95 [4.6-26.4], p <  0.001, respectively). The booklet delivery also improved patient satisfaction on general practitioner communication and high blood pressure management. CONCLUSION: A booklet can improve patient self-reporting of ADEs to their general practitioners. Future research should assess whether it can improve general practitioner management of ADEs and patient's health status. TRIAL REGISTRATION: Trial registry identifier NCT01610817 (2012/05/30).

A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial.

BACKGROUND: While patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities. METHODS: A nation-wide cluster-randomised controlled trial was performed in France, with each cluster defined as a primary care facility. The intervention included professional e-learning training, identification of a risk management advisor, and multidisciplinary meetings to address incident analysis. In the first observational period, a patient safety incident reporting system for professionals was implemented in all facilities. Then, facilities were randomised, and the program was implemented. Incidents were reported over the 15-month study period. Quasi-Poisson models were used to compare reporting rates. RESULTS: Thirty-five facilities (intervention, n = 17; control, n = 18) were included, with 169 and 232 healthcare professionals, respectively, involved. Overall, 7 out of 17 facilities carried out the entire program (41.2%), while 6 did not hold meetings (35.3%); 48.5% of professionals logged on to the e-learning website. The relative rate of incidents reported was 2.7 (95% CI = [0.84-11.0]; p = 0.12). However, a statistically significant decrease in the incident rate between the pre-intervention and post-intervention periods was observed for the control arm (HR = 0.2; 95% CI = [0.05-0.54]; p = 0.02), but not for the intervention arm (HR = 0.54; 95% CI = [0.2-1.54]; p = 0.23). CONCLUSION: This program didn't lead to a significant improvement in the patient safety incident reporting rate by professionals but seemed to sustain reporting over time. Considering that the program was fully implemented in only 41% of facilities, this highlights the difficulty of implementing such multidisciplinary programs in primary care despite its adaptation to the setting. A better understanding of how risk management is currently organized in these multiprofessional facilities is of key importance to improve patient safety in primary care. TRIAL REGISTRATIONS: The study has been registered at clinicaltrials.gov (NCT02403388) on 30 March 2015.

[Information and active patient participation using an interactive booklet in the prescription of antihypertensive drugs in primary care]. / Information et participation active des patients à l'aide d'une brochure interactive lors de la prescription d'antihypertenseurs en soins primaires.

AIM: Antihypertensive drugs are thought to be responsible for adverse drug events in 25% of patients, with severe consequences in 13% of cases. The purpose of this study was to develop an interactive booklet designed to inform and involve patients with a view to preventing adverse drug events. METHODS: The development of the booklet involved several stages, including a literature review, a Delphi survey, a readability assessment, a qualitative study in primary care, a revision process, and graphic design work. 27 experts (patients, general practitioners, public health practitioners, cardiologists, geriatricians, psychologists, economists, pharmacists, nurses and ethicists) participated in the Delphi survey, while the qualitative study was based on a sample that included 7 doctors, 13 patients and 2 healthcare assistants. RESULTS: We developed an interactive booklet containing information items on the benefits and risks of antihypertensive drugs, a care plan to be completed by the patient, and a form for reporting adverse drug events. Ambiguous sentences and incomprehensible medical terms were rephrased. The time required to present the booklet and ease of use were key acceptability criteria for caregivers. Among the patients, the study found that interest in the booklet required clear evidence of an expected benefit. CONCLUSION: An understandable and acceptable interactive booklet was developed using a systematic process to prevent severe adverse drug events in primary care.

A face-to-face national congress experience during the COVID-19 pandemic: A report focussing on the risk of COVID-19 contamination.

BACKGROUND: The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination. OBJECTIVES: The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination. METHODS: We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants. RESULTS: A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 (SD 10) years, 96.2% had been vaccinated against SARS-CoV-2, and 11.4% considered themselves at risk for a severe form of COVID-19 for medical reasons. Concerning the interest in attending the congress face-to-face, mean score was 9 over 10 (SD 1.5). No case of COVID-19 was reported among participants according to the second questionnaire (449 respondents). CONCLUSION: During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress.

What are health professionals' perceptions and attitudes regarding children with early childhood caries and their families? A qualitative research protocol to assess oral health stigma in the medical setting.

INTRODUCTION: Dental caries is one of the most common non-communicable diseases in children. The disease management of caries relies on both a preventive individual approach (fluoridation, risk evaluation) and the surgical treatment of established carious lesions. Similar to other non-communicable diseases (obesity, mental diseases, etc), health professionals' negative perceptions of patients have been shown to affect the quality of disease management. Regarding dental caries in children, some data have indicated the presence of discriminating beliefs and behaviours towards these children and their families in the medical setting. However, oral health stigma related to dental care remains a largely unexplored issue. METHODS AND ANALYSIS: This study presents an exploratory research protocol focusing on the perceptions and attitudes of health professionals towards children with early childhood caries (ECC) and their parents. Semistructured interviews will be conducted among medical and dental health professionals, and verbatim quotations obtained from audio transcriptions will be analysed to identify health professionals' perceptions of ECC and the influence of these perceptions on clinical care for these children. ETHICS AND DISSEMINATION: The research ethics committee of the Department of Family Medicine at University Lyon 1 approved this protocol. The results will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT05284279.

Patient safety incidents are common in primary care: A national prospective active incident reporting survey.

BACKGROUND: The study objectives were to describe the incidence and the nature of patient safety incidents (PSIs) in primary care general practice settings, and to explore the association between these incidents and practice or organizational characteristics. METHODS: GPs, randomly selected from a national influenza surveillance network (n = 800) across France, prospectively reported any incidents observed each day over a one-week period between May and July 2013. An incident was an event or circumstance that could have resulted, or did result, in harm to a patient, which the GP would not wish to recur. Primary outcome was the incidence of PSIs which was determined by counting reports per total number of patient encounters. Reports were categorized using existing taxonomies. The association with practice and organizational characteristics was calculated using a negative binomial regression model. RESULTS: 127 GPs (participation rate 79%) reported 317 incidents of which 270 were deemed to be a posteriori judged preventable, among 12,348 encounters. 77% had no consequences for the patient. The incidence of reported PSIs was 26 per 1000 patient encounters per week (95% CI [23‰ -28‰]). Incidents were three times more frequently related to the organization of healthcare than to knowledge and skills of health professionals, and especially to the workflow in the GPs' offices and to the communication between providers and with patients. Among GP characteristics, three were related with an increased incidence in the final multivariable model: length of consultation higher than 15 minutes, method of receiving radiological results (by fax compared to paper or email), and being in a multidisciplinary clinic compared with sole practitioners. CONCLUSIONS: Patient safety incidents (PSIs) occurred in mean once every two days in the sampled GPs and 2% of them were associated with a definite possibility for harm. Studying the association between organizational features of general practices and PSIs remains a major challenge and one of the most important issues for safety in primary care.

[Morbidity and mortality conference in general practice: about an experiment in Rhône-Alpes]. / Mise en place d'une revue de morbi-mortalité en médecine générale: à propos d'une expérimentation conduite en Rhône-Alpes.

UNLABELLED: A morbidity and mortality conference (MMC) is a collective analysis, retrospective and systemic cases marked by occurrence of death, complication, or event that could cause harm to patient (adverse event). OBJECTIVES: Its aim is the implementation and monitoring of actions to improve the care of patients and patient safety. A group for analysis of adverse events in general practice was created in 2011 in the Rhone-Alps, in order to test the feasibility of a MMC with general practitioners (GPs). METHOD: A charter setting out the ethical framework and the terminology, methodology and the role of individual players was drafted. Then a group of volunteers was created among the members of an association of continuing medical education. Each session has been the subject of a report. The evaluation was conducted through interviews with participants, and with an electronic survey of satisfaction. RESULTS: Since 2011, 12 physicians participated, analysing 36 cases during seven sessions. Reported events were most frequently interested women with a mean age of patients being 48 years (median 46 years). The situations reported were mixed (error diagnostic, therapeutic, adverse drug). Failures are related to care protocols, decision-making, the care environment (frequent disruptive pop) and human factors (caregiver stress). The participants were satisfied with the initiative. Analyses revealed some redundant causes that can be corrected to secure care. Beyond the non-stigmatising approach it may allow doctors to discuss their feelings without making them feel guilty (concept of second victim). CONCLUSION: If such initiatives are still not widespread in ambulatory, they should be promoted by organizations. Openness to other caregivers in Ambulatory is a fundamental change desired by the GP. The National Programme for Patient Safety recently published in February 2013 mentions these aspects, emphasizing the key role of the DPC for acquisition techniques analysis of the causes by caregivers.

[Classifications and definitions of adverse events in primary care: a systematic review]. / Classifications et définitions des événements indésirables associés aux soins primaires: une synthèse de la littérature.

UNLABELLED: In an aim to standardize the terminology used in patient safety research, the World Health Organization (WHO) has recommended the use of internationally acceptable patient safety concepts for the collection and classification of adverse events and near misses in health care settings worldwide. OBJECTIVE: The principal aims of this study were to clarify patient safety terminology and concepts, to suggest a comprehensible definition of medical error, and to propose patient safety classifications for use in primary health care. DESIGN: Systematic review and synthesis of the international medical literature. METHODS: In order to define "medical error" as a health care term and to identify various published or unpublished classifications of medical errors, we searched the Medline, Web of Science, Cochrane Library, Pascal, and French Data Bank of Public Health bibliographical medical databases for the years 2000 through 2011. A grey literature search was carried out using the Google and Google Scholar search engines. We used the recommendations of WHO to analyze these classifications. The principal key words used were: primary care, family practice, patient safety event, adverse event and taxonomy. RESULTS: The online search identified 191 documents; among these, 51 articles, eight reports and two books were deemed appropriate. Twelve classifications were analyzed and compared using WHO recommendations. Eight definitions of medical error were identified during this analysis. CONCLUSION: The WHO Alliance for Patient Safety has clarified the definition of several terms - medical error, adverse event, patient safety event, and near miss - through the development of the International Patient Safety Event Classification. This conceptual framework and classification for patient safety should be applicable across the full spectrum of health care, including primary health care.

[Impact of adverse events on the practices of 15 general practitioners]. / Impact des événements indésirables sur la pratique de 15 médecins généralistes maîtres de stage.

INTRODUCTION: General practitioners are sometimes faced with adverse events, which we define here as "all untoward or unfortunate events occurring unintentionally during the provision of health care services, but also all such events related to any kind of intervention during care." While their social, economic, and health repercussions are often studied, little is known about their effects on general practitioners, except perhaps for their legal consequences. Our principal objectives here were to study the impact of adverse events (including medical errors) on the practices of general practitioners and to study their representations of the concepts of adverse events and medical errors. METHOD: This qualitative work is based on interviews with 15 general practitioners in the Rhone-Alpes region. RESULTS: This study collected 66 real situations experienced and identified as adverse events by the subjects. Analysis shows that these events had a major impact on these practitioners: they caused changes in their procedures for diagnosis and treatment, had sometimes important psychological consequences, induced them to participate in targeted continuing education, and increased their awareness of the legal aspects of some practices, including, for example, record-keeping. Most expressed a need to discuss these situations, especially in peer groups. CONCLUSION: It appears essential to study adverse events and professional practices in primary care and to facilitate their ongoing study, especially in the area of family care.