Patient safety culture in the Primary Health Care

A cross-sectional study with 349 health professionals and PHC managers from a city of Rio Grande do Sul, Brazil. The tool used was Safety Attitudes Questionnaire Ambulatory Version. Data-independent double typing and descriptive and inferential statistical analysis were performed.

Results:

The total score varied between 3.4 and 8.4 with mean (7.0 ± 1.3), positive evaluation in the "Patient Safety" domain (8.2 ± 2.0). Working on the Family Health Strategy and having five to 12 years of work was significant for positive culture. The recommendations to improve the safety culture were: Implementation of protocols, training, communication improvement and resolvability.

Conclusion:

The patient safety culture prevailed. Establishing a constructive safety culture with safe behaviors represents factors for improving patient safety in Primary Care settings.

Descriptors:
Patient Safety; Primary Health Care; Patient Care Team; Organizational Culture; Quality of Health Care

SAQ Domains	Respondent		Mean	Standard Deviation	Median	IQ Interval^* * Interquartile Interval;			Min	Max	α^ Cronbach alpha; SAQ - Safety Attitudes Questionnaire.
SAQ Domains	n%		Mean	Standard Deviation	Median	25	50	75	Min	Max
SAQ-AV Total	217	85.4	7.0	1.3	7.0	6.0	7.0	7.3	3.4	8.4	0.86
Work satisfaction	250	98.4	7.3	1.0	7.3	7.0	7.3	8.2	3.3	10.0	0.41
Teamwork Culture	252	99.2	7.2	2.0	7.3	6.3	7.3	9.0	1.3	10.0	0.39
Working Conditions	242	95.3	5.0	1.3	5.0	4.0	5.0	5.4	1.4	10.0	0.42
Communication	242	95.3	7.1	1.2	7.2	6.3	7.2	8.1	2.3	10.0	0.76
Patient Safety	254	100.0	8.2	1.8	8.7	7.3	8.7	10.0	0.0	10.0	0.63
Permanent Education	250	98.4	6.5	2.1	6.7	4.7	6.7	8.0	7.0	10.0	0.55
Unit Management	251	98.8	7.4	2.1	7.5	6.0	7.5	9.5	0.0	10.0	0.69
Stress Recognition	245	96.5	6.3	1.1	6.4	5.8	6.4	6.9	1.3	9.3	0.27
Error	252	99.2	5.0	2.0	5.5	4.0	5.5	6.0	0.0	9.0	0.35

Variable	Negative Culture (<7.5)		Positive Culture (≥7.5)^* * Cut-off;		p value^ Pearson Chi-square test;
Variable	n	%	n	%	p value^ Pearson Chi-square test;
Sex					0.761
Male	31	77.5	9	22.5
Female	141	79.7	36	20.3
Age					0.074
22 to 39 years	76	72.4	29	27.6
40 to63 years	74	83.1	15	16.9
Marital status					0.666
Married or with a partner	111	79.9	28	20.1
Single or without a partner	58	77.3	17	22.7
Schooling					0.225
High school	56	74.7	19	25.3
Higher education	116	81.7	26	18.3
Professional category					0.050
Community Health Agent	37	80.4	9	19.6
Nurse	36	80.0	9	20.0
Nursing technician	22	66.7	11	33.3
Doctor	28	75.7	9	24.3
Dentist	20	87.0	3	13.0
Oral health assistant	7	77.8	2	22.2
Nursing auxiliary	5	83.3	1	16.7
Others^* ***** Physiotherapist, physical educator, psychologist, pharmacist, nutritionist, social worker, speech therapist.	17	94.4	1	5.6

Variable	Negative Culture (<7.5)		Positive Culture (≥7.5)*		p value
Variable	n	%	n	%	p value
Sector of performance					0.042^ Chi-Square test with correction;
BHU	41	82.0	9	18.0
FHS	66	73.3	24	26.7
Mixed Unit	53	81.5	12	18.5
Management	12	100.0	-	-
Workshift					0.185^ Chi-Square test with correction;
Morning	23	88.5	3	11.5
Afternoon	7	87.5	1	12.5
Mixed	142	78.0	40	22.0
Bond					0.494^* ***** Pearson Chi-square test;
Hired	26	83.9	5	16.1
Approved in public contest	146	78.5	40	21.5
PHC time experience					0.001^* ***** Pearson Chi-square test;
Up to 4 years	58	82.9	12	17.1
5 to 12 years	42	63.6	24	36.4
More than 13 years	68	88.3	9	11.7
Time working in this unit					0.844^* ***** Pearson Chi-square test;
Up to 1 year	57	77.0	17	23.0
2 to 5 years	55	79.7	14	20.3
More than 6 years	59	80.8	14	19.2
If like their job					0.721^** ****** Fisher's Exact Test; BHU - Basic Health Units; FHS - Family Health Strategies; PHC - Primary Health Care.
Yes	167	79.1	44	20.9
No	4	80.0	1	20.0
Chose working in that unit					0.877^* ***** Pearson Chi-square test;
Yes	101	78.9	27	21.1
No	71	79.8	18	20.2
Had any training					0.292^* ***** Pearson Chi-square test;
Yes	87	76.3	27	23.7
No	83	82.2	18	17.8
Has another job					0.193^* ***** Pearson Chi-square test;
Yes	38	86.4	6	13.6
No	134	77.5	39	22.5
Form of contact with the patient					0.209^** ****** Fisher's Exact Test; BHU - Basic Health Units; FHS - Family Health Strategies; PHC - Primary Health Care.
Direct	163	78.4	45	21.6
Indirect	9	100.0	-	-

Dimension	Recommendation
Protocols	Implement protocols for Patient Safety and standardize care protocols (acute, chronic and emergency diseases).
Skills	Training, courses, seminars, Permanent Education and research.
Skills	Periodic team meetings to organize the work process and feedback of the activities carried out.
Working environment and infrastructure	Appropriate accessibility for users with special needs.
	Supply of materials for Urgency and Emergency care.
	Proper sterilization center.
Working Conditions and Overload	Sufficient number of professionals to meet the demand.
	Availability of specialists for reference care.
	Fixed and full-time medical staff.
Communication	Effective communication between professionals and users. Strengthen the reception of users. Identify patients correctly. Guide patients on the safe treatment and use of medications. Coordination more active and open to suggestions regarding the problems of unity
Error	Admit and dialogue about the error. Identify incidents.
Error	Medical prescriptions with legible letters.
Resolvability	Finish what is possible from the service in the unit and refer for reference when necessary.
	Referral and resolvable counter-referral.
	Discuss with the team the causes of the incidents and the behaviors adopted.
	Risk stratification by clinical and social criteria of users.

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[1] Corresponding Author: Marina Mazzuco de Souza E-mail: marina.mazzuco@yahoo.com.br