Exploring patient participation in reducing health-care-related safety risks

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Exploring patient participation in reducing health-care-related safety risks 82 Fig . 5 .2 . Relationship between patients’ knowledge and the number of medicines taken How many medicines do you take every day? More than 7 5–7 3–5 Up to 3 % 0 20 40 60 80 100 Do you know the names and dosages of all medicines you take? Almost two thirds said they discussed their medication during every visit to the doctor, but it is not known what aspects of pharmacotherapy were covered in these discussions (for example, does the patient obtain answers to all their questions, does the doctor provide clear and patient-friendly information and does the patient understand the answers?). Regarding discussions about medicines taken, most (93%) claimed they, their family or an accompanying person initiated such conversations during medical visits. This clearly shows there are problems related to drug use that require explanation and clarification. Only 7% of respondents (all women) stated that conversations had been started by the physician, which indicates insufficient pharmacotherapy surveillance and monitoring by physicians and suggests that patients are rarely asked about ADRs. It seems that doctors mainly refer to the written information in the patient’s file. Only 6% of respondents stated that the doctor mentioned or discussed potential interactions related to the medicines being taken: 94% of patients may therefore not be aware that prescribed drugs might have interactions with other medicines or with OTC drugs and/or dietary supplement(s). The survey results suggest that few doctors were interested in their patients’ medication history. Only 6% of patients stated that their doctor always asked about medicines being taken before prescribing a new one (Fig. 5.3): over a third (37%) reported that it “never happens” and more than half (57%) that it was “sometimes” discussed. This implies that almost 40% of patients are at risk of adverse interactions, as the doctor – unless he or she has thoroughly consulted the patient’s file and the recorded information is complete – will not be aware of which medicines have been taken recently and will not knowledgeably manage the risk of potential interactions. Only one respondent indicated that the doctor asked about previous ADEs when prescribing a new medication. Over a third (37%) confirmed that this “sometimes” happened but 61% (30 respondents) claimed the doctor never asked about this. Yes No
Fig . 5 .3 . Frequency with which doctors inquire about medication history 57% 37% Patient safety, rights and medication safety in primary care in Poland Never (18) Always (3) Sometimes (28) Number of responses: 49 Twenty-six per cent confirmed that they had refrained from taking a prescribed medicine having learnt about contraindications from the medicine’s information that the doctor had not mentioned. Most respondents (82%) confirmed that they had experienced an ADR. This indicates the probability of pharmacotherapy not always being adequately monitored and not including the proper contraindications, limitations and risk of interactions. In light of previous findings related to doctors’ lack of interest in patients’ medicines history and experience of ADRs, this might be a result of limited interest, but could also be due to lack of time. More than half of the patients (55%) stated that they had required treatment after experiencing an ADR. This might imply that patients’ right to safe treatment is being compromised in an era of health care cost reductions. Fig. 5.4 makes it clear that only 20% of patients stated they always asked about safety and potential drug interactions when buying OTC drugs and/or dietary supplements. Just over a quarter (27%) claimed they had never done so, and just over half (53%) confirmed that they “sometimes” did. Eighty per cent of respondents therefore seldom used potential sources of information about drug safety outside of the doctor’s office. This might contribute to the level of pharmacotherapy complications. Fig . 5 .4 . Frequency with which patients ask about interactions between OTC and prescription medicines 53% 27% 6% 20% Never (13) Always (10) Sometimes (26) Number of responses: 49 83
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Exploring patient participation in
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ABSTRACT Patients’ rights have be
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iv Patient information: the link be
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vi LIST OF TABLES, FIGURES AND BOXE
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ACKNOWLEDGEMENTS The editors would
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LIST OF ABBREVIATIONS ABHR alcohol-
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FOREWORD Health is a social value a
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ChApTER 1. pATIENTS’ RIGhTS AND p
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Box 1 .1 . contd Reporting and Lear
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The causal mechanisms through which
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» be involved in routine monitorin
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elationships within the complex env
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ChApTER 2. pATIENTS’ RIGhTS AND p
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CoE Recommendation 2006/7 of the Co
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The 2005 United States act on patie
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The right to participate in policy-
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The right to participate in quality
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» engaging with patient representa
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hampered by the written and spoken
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prevents misunderstandings and shap
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Health care providers should nevert
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Recommendation 7 - Encourage the av
Page 45 and 46: 20. Constitution of the World Healt
Page 47 and 48: ChApTER 3. pATIENT pARTICIpATION IN
Page 49 and 50: awareness of the sociomedical burde
Page 51 and 52: Patient participation in hand hygie
Page 61 and 62: Blood transfusion safety in France:
Page 65 and 66: Box 4 .1 . Definitions of adverse e
Page 67 and 68: Fig . 4 .4 . Distribution of advers
Page 73 and 74: The heterogeneity of situations and
Page 83 and 84: Fig . 4 .12 . Patients’ response
Page 91 and 92: Patient safety, rights and medicati
Page 95: Patient safety, rights and medicati
Page 107 and 108: ChApTER 6. pATIENT pARTICIpATION IN
Page 109 and 110: Patient participation in elective s
Page 111 and 112: e desirable to have a special statu
Page 117 and 118: inspections of surgical services to
Page 133 and 134: » being involved in monitoring and
Page 135 and 136: Other studies on patient attitudes
Page 137 and 138: Information about patients’ exper
Page 139 and 140: available evidence suggests that in
Page 141 and 142: Adverse events Respondents from the
Page 143 and 144: Feeling safe Five per cent of hospi
Page 145 and 146: probability proportional to populat
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care professionals’ and patients
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group recommends that patient invol
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13. Hibbard JH et al. Can patients
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52. Triemstra M et al. Measuring cl
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2009 (http://www.bradfordresearch.n
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of a small-scale patient survey add
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Box 8 .2 . Curricula and CME Chapte
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is provided through interaction of
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Box 8 .4 . Patient education Chapte
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ANNEX 1. QUOTATIONS FROM INTERNATIO
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(2) When designing adverse event re
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17) If yes, do you think this was m
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Box A3 .1 . Reporting procedure Pat
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Box A3 .2 . contd Haemosiderosis Ha
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ANNEX 4. pATIENT QUESTIONNAIRE ABOU
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ANNEX 6. WhO pATIENT SAFETY pROGRAM
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especially those in intensive care.
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ANNEX 7. hANDOVER pROjECT Paul Bara
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(a) Provide new insight into the ro
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Johnson J, Barach P. Handovers of p
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Enhancing the patients’ role in p
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Enhancing the patients’ role in p
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Exploring patient participation in reducing health-care-related safety risks

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