Peter J Edwards, Samuel Finnikin, Fay Wilson, Ian Bennett-Britton, Andrew Carson-Stevens, Rebecca K Barnes, Rupert A Payne
{"title":"Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020.","authors":"Peter J Edwards, Samuel Finnikin, Fay Wilson, Ian Bennett-Britton, Andrew Carson-Stevens, Rebecca K Barnes, Rupert A Payne","doi":"10.3399/BJGP.2024.0057","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice.</p><p><strong>Aim: </strong>Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence.</p><p><strong>Design and setting: </strong>This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database.</p><p><strong>Method: </strong>A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression.</p><p><strong>Results: </strong>The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients' condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, <i>P</i> = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, <i>P</i> = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, <i>P</i> = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e80-e89"},"PeriodicalIF":5.3000,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694318/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of General Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3399/BJGP.2024.0057","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"Print","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice.
Aim: Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence.
Design and setting: This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database.
Method: A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression.
Results: The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients' condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, P = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, P = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, P = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, P<0.001).
Conclusion: The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.
背景：在非工作时间提供安全网建议（SNA）是公认的安全护理标准，但在实践中发生的频率如何尚不清楚。目的：评估非工作时间初级护理中记录的 SNA 的频率和类型，并探索与之相关的因素：使用伯明翰非工作时间全科实践研究数据库进行回顾性队列：使用安全网编码工具对 2013 年 7 月至 2020 年 2 月期间每月 30 份成人咨询记录进行分层抽样评估。使用线性回归和逻辑回归对相关性进行检验：每次就诊的 SNA 总频率为 78.0%，从 75.7%（2014 年）增至 81.5%（2019 年）。随着时间的推移，特定 SNA 的比例和患者被告知要注意的症状平均数量也在增加。最需要注意的症状是患者的病情是否恶化，其次是症状是否持续，但只有五分之一的问诊记录中包含了持续症状的复诊时限。与电话会诊相比，面对面治疗中心会诊中记录 SNA 的频率更高（Odds Ratio [OR]=1.77，p=0.02），记录可能感染的 SNA 的频率更高（OR=1.53，p=0.006），记录精神（与身体）健康会诊的 SNA 的频率较低（OR=0.33，p=0.002），记录计划随访的 SNA 的频率较低（OR=0.34，p=0.002）：在门诊中记录的 SNA 频率高于之前报告的非住院护理。随着时间的推移，SNA 的频率和包含具体建议的比例都在增加，但本研究强调了 SNA 可改进的潜在咨询，如心理健康和电话咨询。
期刊介绍：
The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide.
BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
