title: Reducing Medical Errors in Primary Care Using a Pragmatic Complex Intervention.
abstract: This study aimed to develop an intervention to reduce medical errors and to determine if the intervention can reduce medical errors in public funded primary care clinics. A controlled interventional trial was conducted in 12 conveniently selected primary care clinics. Random samples of outpatient medical records were selected and reviewed by family physicians for documentation, diagnostic, and management errors at baseline and 3 months post intervention. The intervention package comprised educational training, structured process change, review methods, and patient education. A significant reduction was found in overall documentation error rates between intervention (Pre 98.3% [CI 97.1-99.6]; Post 76.1% [CI 68.1-84.1]) and control groups (Pre 97.4% [CI 95.1-99.8]; Post 89.5% [85.3-93.6]). Within the intervention group, overall management errors reduced from 54.0% (CI 49.9-58.0) to 36.6% (CI 30.2-43.1) and medication error from 43.2% (CI 39.2-47.1) to 25.2% (CI 19.9-30.5). This low-cost intervention was useful to reduce medical errors in resource-constrained settings.
authors.affiliation: Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia khooem@um.edu.my.
authors.forename: Ee Ming
authors.initials: EM
authors.lastname: Khoo
authors.affiliation: Department of Health Outcomes Research, Institute for Health Systems Research, Ministry of Health Malaysia, Malaysia.
authors.forename: Sondi
authors.initials: S
authors.lastname: Sararaks
authors.affiliation: Luyang Health Clinic, Ministry of Health Malaysia, Sabah, Malaysia.
authors.forename: Wai Khew
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Su May
authors.initials: SM
authors.lastname: Liew
authors.affiliation: Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: Ai Theng
authors.initials: AT
authors.lastname: Cheong
authors.affiliation: Klinik Kesihatan Tanglin, Kuala Lumpur, Malaysia.
authors.forename: Azah
authors.initials: A
authors.lastname: Abdul Samad
authors.affiliation: Department of Medical Services, Ministry of Health Malaysia, Putrajaya, Malaysia.
authors.forename: Kalsom
authors.initials: K
authors.lastname: Maskon
authors.affiliation: Office of the Deputy Director General of Health (Research & Technical Support), Ministry of Health Malaysia, Putrajaya, Malaysia.
authors.forename: Maimunah A
authors.initials: MA
authors.lastname: Hamid
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008296:Malaysia; D019300:Medical Errors / Q000517:prevention & control*; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D015397:Program Evaluation; D017150:Public Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D013663:Teaching
keywords: Diagnostic errors; medical errors; medication errors; nurse practitioners; primary health care