Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study

Bianca Silva; Zlata Ožvačić Adžić; Pierre Vanden Bussche; Esther Van Poel; Bohumil Seifert; Cindy Heaster; Claire Collins; Canan Tuz Yilmaz; Felicity Knights; Maria de la Cruz Gomez Pellin; Maria Pilar Astier Peña; Neophytos Stylianou; Raquel Gomez Bravo; Venija Cerovečki; Zalika Klemenc Ketis; Sara Willems

doi:10.3390/ijerph191710515

Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study

Int J Environ Res Public Health. 2022 Aug 24;19(17):10515. doi: 10.3390/ijerph191710515.

Authors

Bianca Silva¹, Zlata Ožvačić Adžić^{2

3}, Pierre Vanden Bussche¹, Esther Van Poel¹, Bohumil Seifert⁴, Cindy Heaster⁵, Claire Collins⁶, Canan Tuz Yilmaz⁷, Felicity Knights⁸, Maria de la Cruz Gomez Pellin⁹, Maria Pilar Astier Peña^{10

11}, Neophytos Stylianou^{12

13}, Raquel Gomez Bravo^{14

15}, Venija Cerovečki^{2

3}, Zalika Klemenc Ketis^{16

17

18}, Sara Willems¹

Affiliations

¹ Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium.
² Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
³ Health Centre Zagreb-Centar, 10000 Zagreb, Croatia.
⁴ Institute of General Practice, First Medical Faculty, Charles University, CZ-121 08 Prague, Czech Republic.
⁵ Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia.
⁶ Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland.
⁷ Family Medicine Department, Bursa Uludag University, 16130 Bursa, Turkey.
⁸ Population Health Research Institute, St George's University of London, London SW17 0RE, UK.
⁹ Department of Social and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria.
¹⁰ Primary Health Centre Universitas, Aragon Health Services, 50009 Zaragoza, Spain.
¹¹ Medical School, Universidad de Zaragoza, GIBA-ISS-Aragón, 50009 Zaragoza, Spain.
¹² RTD Talos, 2404 Nicosia, Cyprus.
¹³ International Institute for Compassionate Care, 2415 Nicosia, Cyprus.
¹⁴ CHNP, Rehaklinik, L-9002 Ettelbruck, Luxembourg.
¹⁵ Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg.
¹⁶ Ljubljana Community Health Centre, 1000 Ljubljana, Slovenia.
¹⁷ Department of Family Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia.
¹⁸ Department of Family Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.

Abstract

The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.

Keywords: COVID-19; PRICOV-19; general practice; infectious disease; medical education; multi-country; patient safety; primary health care; quality of care; safety culture; vocational training.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / prevention & control
Cross-Sectional Studies
Humans
Pandemics / prevention & control
Primary Health Care
Safety Management

Grants and funding

The PRICOV-19 data collection was undertaken without funding in individual countries. A small grant was received by Ghent University from the European General Practice Research Network (EGPRN) to cover data cleaning; no grant number applies. Felicity Knights is supported by a Health Education England/NIHR Academic Clinical Fellowship. The APC for this paper was funded with support from the University Foundation of Belgium.