A study of the prevalence of adverse events in primary healthcare in Spain

Eur J Public Health. 2012 Dec;22(6):921-5. doi: 10.1093/eurpub/ckr168. Epub 2011 Nov 29.


Background: Healthcare practices involve risks for patients, but there has been little research to date on the occurrence of adverse events (AE) in primary care (PC). The frequency of AE in PC in Spain, the factors that contribute to their occurrence, their severity and their preventability, were analysed.

Methods: Observational cross-sectional study was carried out in 48 PC centres in 16 regions of Spain. PC professionals were asked to assess whether the AE was caused by the healthcare or if it was an expectable consequence of the patient's underlying condition. A total of 452 healthcare professionals who attended 96 047 consultations were involved.

Results: A total of 773 AE were identified, so that the point prevalence of AE was 0.8% [95% confidence interval (CI) 0.76-0.85]. A majority of AE (64.3%) were considered preventable and only 5.9% were severe, usually related to medication [odds ratio (OR) = 4.6; 95% CI 2.1-10.3]. The most frequent causal factor of the AE was associated with medication (adverse drug reactions and medication errors), but problems in communication and management were at the root of many of the AE. Nurses reported more preventable AE (OR = 1.9; 95% CI 1.2-2.8).

Conclusion: In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Communication
  • Confidence Intervals
  • Cross-Sectional Studies
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data*
  • Prevalence
  • Primary Health Care / organization & administration
  • Primary Health Care / standards*
  • Referral and Consultation / statistics & numerical data*
  • Rural Population
  • Spain / epidemiology
  • Urban Population