Effect of being a training practice on outcomes related to the safety culture of primary care practices in the PRICOV-19 study

Bianca Silva, Zlata Ozvacic Adzic, Piet Vanden Bussche, Esther Van Poel, Sara Willems

Introduction:
COVID-19 introduced substantial changes to family practices' daily work. Teaching practices needed to adapt both in terms of clinical work and teaching in a way that enabled the teaching process, while maintaining safe and high quality care. This included safety measures for patients, clinicians and trainees, as well as outreach activities to the vulnerable patient populations, while also affecting the wellbeing of teachers and trainees. Previous research has shown higher quality care provided in teaching practices. Our study aimed to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of a primary care practice.

Method:
PRICOV-19 is a multi-country cross-sectional study that researched how primary care practices were organized during the pandemic. Data collection happened from November 2020 to December 2021. We categorized practices in training and non-training and selected outcomes from the database that related from the following dimensions of safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. We built mixed-effects regression models to analyze the effect of being a training practice in each of the outcomes, while controlling for relevant confounders.

Results:
We had 2889 (56%) non-training practices and 2272 (44%) training practices in our database. Being a training practice had a significant association with lower risk for adverse mental health events (OR: 0.74; CI:0.62-0.89), higher number of safety measures related to patient flow (Beta: 0.20; CI: 0.09-0.31), higher chance of outreach initiatives (RR: 1.07; CI:1.01-1.14), higher number of safety incidents reported (RR: 1.11; CI:1.05-1.18) and more protected time for meetings (Beta: 0.11; CI:0.04-0.17). No significant associations were found for infection prevention equipment, availability of triage information, use of a phone protocol, infection prevention measures.

Conclusions:
In our sample, training practices appear to have a stronger safety culture than non-training practices.

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