Safety netting in routine primary care consultations: an observational study using video-recorded UK consultations.
health communication
patient safety
primary care
safety netting
video-recording
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
18
03
2019
accepted:
02
07
2019
pubmed:
20
11
2019
medline:
17
6
2020
entrez:
20
11
2019
Statut:
epublish
Résumé
Safety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health. To assess when and how safety-netting advice is delivered in routine GP consultations. This was an observational study using 318 recorded GP consultations with adult patients in the UK. A safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables. A total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems. GPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient's part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.
Sections du résumé
BACKGROUND
BACKGROUND
Safety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.
AIM
OBJECTIVE
To assess when and how safety-netting advice is delivered in routine GP consultations.
DESIGN AND SETTING
METHODS
This was an observational study using 318 recorded GP consultations with adult patients in the UK.
METHOD
METHODS
A safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.
RESULTS
RESULTS
A total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.
CONCLUSION
CONCLUSIONS
GPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient's part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.
Identifiants
pubmed: 31740458
pii: bjgp19X706601
doi: 10.3399/bjgp19X706601
pmc: PMC6863676
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e878-e886Informations de copyright
© British Journal of General Practice 2019.
Références
PLoS Med. 2017 Jan 17;14(1):e1002217
pubmed: 28095408
Patient Educ Couns. 2014 May;95(2):248-53
pubmed: 24569180
Postgrad Med J. 2011 Jun;87(1028):394-9
pubmed: 21378007
Br J Gen Pract. 2019 Nov 28;69(689):e869-e877
pubmed: 31740456
BMC Fam Pract. 2014 May 27;15:105
pubmed: 24885298
Br J Gen Pract. 2011 Jan;61(582):43-6
pubmed: 21401991
BMJ. 2016 Nov 9;355:i5515
pubmed: 28291732
Br J Gen Pract. 2019 Jan;69(678):e70-e79
pubmed: 30510099
BMJ. 2016 Dec 5;355:i6411
pubmed: 27919933
Patient Educ Couns. 2008 May;71(2):157-68
pubmed: 18356003
BMC Fam Pract. 2013 Sep 25;14:140
pubmed: 24066842
Br J Gen Pract. 2018 Jul;68(672):e505-e511
pubmed: 29739779
Br J Gen Pract. 2015 Dec;65(641):e838-44
pubmed: 26622037
BMJ Open. 2014 Jan 14;4(1):e003874
pubmed: 24430877
Br J Gen Pract. 2018 Jan;68(666):e63-e72
pubmed: 29255111
Eur J Gen Pract. 2016;22(1):3-8
pubmed: 26578087
Br J Gen Pract. 2009 Nov;59(568):872-4; discussion 874
pubmed: 19861036
Br J Gen Pract. 2017 May;67(658):e345-e351
pubmed: 28396369
Arch Dis Child. 2011 Sep;96(9):810-6
pubmed: 21642270
Arch Dis Child Educ Pract Ed. 2013 Dec;98(6):232-5
pubmed: 24046395
J R Coll Gen Pract. 1984 Nov;34(268):607-10
pubmed: 6502570
Br J Gen Pract. 2018 May;68(670):e323-e332
pubmed: 29686134
Br J Gen Pract. 2013 Jan;63(606):e37-46
pubmed: 23336459
Arch Dis Child Educ Pract Ed. 2014 Apr;99(2):48-53
pubmed: 24164728