Background Patient safety incidents defined as any unintended or unexpected incident that could have or were judged to have led to patient harm, are reported as relatively common. In this study patient complaints have been used as an indicator to uncover the occurrence of patient safety incidents in primary care emergency units (PCEUs) in Norway. Methods Ten PCEUs in major cities and rural parts of Norway participated. These units cover one third of the Norwegian population. A case-control design was applied. The case was the physician that evoked a complaint. The controls were three randomly chosen physicians from the same PCEU as the physician having evoked the complaint. The following variables regarding the physicians were chosen: gender, citizenship at, and years after authorization as physician, and specialty in general practice. The magnitude of patient contact was defined as the workload at the PCEU. The physicians’ characteristics and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The rest of the variables were then obtained from the Norwegian physician position register. Logistic regression was used to estimate odds ratio for complaints both unadjusted and adjusted for the independent variables. The data were analyzed using SPSS (Version25) and STATA. Results A total of 78 cases and 217 controls were included during 18 months (September 1st 2015 till March 1st 2017). The risk of evoking a complaint was significantly higher for physicians without specialty in general practice, and lower for those with medium low and medium high workload compared to physicians with no duty during the fourteen-day period prior to the index consultation. The limited strength of the study did not make it possible to assess any correlation between workload and the other variables (physician’s gender, seniority and citizenship at time of authorization). Conclusions Continuous medical training and achieving the specialty in general practice were decisively associated with a reduced risk for complaints in primary care emergency services. Future research should focus on elements promoting quality of care such as continuing education, duty rosters and other structural and organizational factors.

Objective: The aim of this study was to examine the associations between characteristics of physicians working in primary care emergency units (PCEUs) and the outcome of assessments of the medical records. Design: Data from a previous case-control study was used to evaluate factors related to medical errors. Setting: Ten Norwegian PCEUs were included. Subjects: Physicians that had evoked a patient complaint, and a random sample of three physicians from the same PCEU and time period as the physician who had evoked a complaint. Recorded physician characteristics were: gender, seniority, citizenship at, and years after authorization as a physician, specialty in general practice, and workload at the PCEU. Main outcome measures: Assessments of the medical records: errors that may have led to harm, no medical error, or inconclusive. Results: In the complaint group 77 physicians were included, and in the random sample group 217. In the first group, 53.2% of the medical records were assessed as revealing medical errors. In the random sample group, this percentage was 3.2. In the complaint group the percentages for no-error and inconclusive for the female physicians were 30.8 and 15.4; and for the male physicians 9.8 and 27.3, p ¼ 0.027. Conclusion:In the group of complaints there was a higher percentage with no assessed medical error, and a lower percentage with inconclusive assessments of medical errors, among female physicians compared to their male colleagues. We found no other physician factors that were associated with assessed medical errors. Future research should focus on the underlying elements of these findings.

General practitioners (GPs) in Norway are in a unique position to influence their patients' lifestyles during consultations. The specialty of family medicine has been recognized in Norway since 1985. In continuing medical education, nutrition issues are integrated with the discussion of relevant diseases. The first book on health education for Norwegian general practice (1990) contains a set of general dietary guidelines. GPs are informed of the results of the National Health Screening Service, which measures blood pressure and serum lipids and records smoking habits. Serum cholesterol concentrations and coronary artery disease mortality are declining. GPs have been involved in this achievement, although they were found in 1988 to set more conservative cutoffs of serum cholesterol concentrations for dietary advice than an expert committee. GPs have been directly involved in preparing the latest cholesterol guidelines. In 1994 Norwegian GP organizations started a project of quality indicators in general practice (SATS). Of the four conditions that are themes for the first project, treatment of diabetes mellitus has a major nutritional aspect.

Background Patient safety incidents are reported as relatively common. To unravel the reasons for these incidents in primary care emergency units (PCEU), patient complaints have been used as an outset. Methods We included the PCEUs in ten major cities and rural parts of Norway, covering one third of the population. In the initial part of our study a case-control design was used to evaluate factors related to complaints. The controls where a random sample of three physicians from the same PCEU and time-period as the physician having evoked a complaint. The inclusion period was 18 months (September 1st 2015 till March 1st 2017). The physician characteristics were: gender, seniority, citizenship at authorization and specialty in general practice. Workload was defined as the magnitude of patient contacts. The physician identities and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The other variables were obtained from the Norwegian physician position register. In the present study a total of 77 physicians were included in the complaint group and 217 in the random sample group. The assessments of the medical records were divided in three groups: medical error, inconclusive and no medical error. Associations between these groups, physician characteristics and workload, were tested by chi-square, Fisher’s exact and t-tests separately for the complaint and randomized group. The data were analyzed using SPSS. Results In the complaint group 53.2% of the medical records were assessed as being erroneous. In the random sample group this percentage was 3.2. The proportion inconclusive assessments was similar in both groups (29.9 and 27.6%). In the complaint group the percentages for no-error and inconclusive for the female physicians were 30.8 and 15.4; and for the male physicians 9.8 and 27.3, p=0.027. Conclusions In the complaint group male physicians had the lowest percentage no-error, and the highest percentage of inconclusive medical record for assessing medical errors, compared to their female colleagues. The Norwegian regulations for working in a PCEU may have modulated the impact of the other variables. Future research should focus on the underlying elements for these findings.