05 août 2022

Davantage de place pour Zoom entre première et deuxième ligne

Background. The Covid-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. Objectives. We explored the type and nature of patient safety incidents in French primary care settings during the Covid-19 first wave to make tentative recommendations for improvement. Methods. A national patient safety incident reporting survey was distributed to general practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International classification for patient safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials. gov : NCT04346121. Results. Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting Covid-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. Conclusion. Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-Covid-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.

  • Il n’y a pas qu’en médecine hospitalière qu’il convient de tirer les leçons des crises successives de la pandémie du SARS-CoV-2. Voici un beau travail en soins primaires, qui souligne les difficultés qu’il conviendra de surmonter. La première est l’inquiétude face aux contaminations au contact de patients, le manque de formation à des équipements de protection par ailleurs indisponibles. La deuxième concerne la prévention des conséquences du confinement chez des patients fragiles (il y a eu des directives en ce sens, qui ont négligé toutefois les patients dépendants de drogues). Enfin, la communication avec l’hôpital ne s’est pas adaptée, laissant le généraliste seul face aux résultats d’examens demandés. Les téléconférences ne sont pas assez sorties du cercle hospitalier.

Fournier JP, Amelineau JB, Hild S, et al. Patient-safety incidents during Covid-19 health crisis in France: an exploratory sequential multi-method study in primary care. Eur J Gen Pract 2021;27(1):142-151. Doi : 10.1080/13814788.2021.1945029.