Once the questionnaires are completed, SinergiAPS automatically generates a report with the results of the audit. This report is specific to each health center and includes a comparison with other participating centers to facilitate benchmarking. Health centers are encouraged to form a working group consisting of around 3-6 professionals, with a designated leader. This team is responsible for gaining access to the result reports and other functionalities of the SinergiAPS web tool.

The working team of each center meets to design patient safety improvement plans based on the issues identified in the result report for their center. To this end, the SinergiAPS web tool provides a series of resources, training materials, and recommendations on how to improve patient safety in Primary Care. It also offers a follow-up template to collect and evaluate the measures proposed by the centers to address the potential safety issues identified.

First, we conducted systematic literature reviews on tools to involve patients in patient safety and on the use of questionnaires to improve the quality of healthcare for patients. Subsequently, we conducted a series of studies interviewing patients and primary care professionals, who actively participated in the design of SinergiAPS. On the other hand, we carried out the translation and transcultural adaptation of the PREOS-PC questionnaire (the basis of the SinergiAPS intervention, as it is the questionnaire used for auditing health centers). Once developed, we piloted SinergiAPS in a study involving 10 health centers in Mallorca. This study showed the potential of the intervention to reduce the rate of avoidable hospitalizations, which decreased by 42% (p=0.07), as well as to identify improvements in the intervention that were introduced before its evaluation in the clinical trial. Subsequently, SinergiAPS was evaluated in a clinical trial with 59 health centers in Mallorca and Catalonia (12 months of follow-up).

The trial, which concluded in September 2021, was heavily affected by the outbreak of the COVID-19 pandemic, so health centers were unable to carry out the intervention as originally planned. However, in a qualitative study with primary care professionals who received the SinergiAPS intervention during the clinical trial, we observed a high level of acceptability and perceived usefulness of SinergiAPS among healthcare professionals.

For more information on the preliminary results of the clinical trial, check out our video presentation and infographic.

SinergiAPS has already been used in more than 40 health centers, which have participated in various research studies aimed at evaluating this tool. We have interviewed over fifteen primary care professionals who have used SinergiAPS for months, and they highlight that:

• The involvement of patients through the questionnaire is essential for improving patient safety.
• The SinergiAPS tool (simple yet comprehensive) has great value, and therefore, they recommend its routine use in Health Centers.

“ SinergiAPS has helped us identify the critical points. And it has made us step up our efforts”

Health center doctor in Mallorca.

“Before, it was very difficult; we had no way of analyzing what the patient thought, and now we do.”

Health center nurse in Tarragona.

1. Serrano-Ripoll MJ, Fiol-deRoque MA, Valderas JM, Zamanillo-Campos R, Llobera J, de Labry Lima AO, et al. Feasibility of the SINERGIAPS (“Sinergias entre profesionales y pacientes para una Atención Primaria Segura”) intervention for improving patient safety in primary care. Family practice. 2022.
2. Ricci-Cabello I, Yañez-Juan AM, Fiol-deRoque MA, Leiva A, Llobera Canaves J, Parmentier FBR, et al. Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data. Journal of Clinical Medicine. 2021;10(8).
3. Mounce LTA, Salema N-E, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Kadam UT, et al. Development of 2 Short Patient-Report Questionnaires of Patient Safety in Primary Care. Journal of patient safety. 2021.
4. Fiol-deRoque MA, Serrano-Ripol MJ, Gens-Barberà M, Sánchez E, Mayer MA, Martín-Luján F, et al. [Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]. Atencion primaria. 2021;53 Suppl 1(Suppl 1):102222.
5. Serrano-Ripoll MJ, Ripoll J, Briones-Vozmediano E, Llobera J, Fiol-deRoque MA, Ricci-Cabello I. Exploring primary health care professionals’ perceptions about a patient feedback intervention to improve patient safety in Spanish primary health care centres: a qualitative study. Family practice. 2020.
6. Serrano-Ripoll MJ, Llobera J, Valderas J, Olry de Labry Lima A, Fiol-deRoque MA, Ripoll J, et al. Cross-Cultural Adaptation, Validation and Piloting of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Questionnaire for Its Use in Spain. Journal of Patient Safety – aceptado 14 octubre 2020. 2020.
7. Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM. Identifying Factors Leading to Harm in English General Practices: A Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis. Journal of patient safety. 2020.
8. Campbell SM, Bell BG, Marsden K, Spencer R, Kadam U, Perryman K, et al. A Patient Safety Toolkit for Family Practices. Journal of patient safety. 2020;16(3):e182-e6.
9. Serrano-Ripoll MJ, Ripoll J, Llobera J, Valderas JM, Pastor-Moreno G, Olry de Labry Lima A, et al. Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol. BMJ open. 2019;9(12):e031367.
10. Ricci-Cabello I, Stevens S, Dalton ARH, Griffiths RI, Campbell JL, Valderas JM. Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling. Health services research. 2018;53(1):430-49.
11. Ricci-Cabello I, Saletti-Cuesta L, Slight SP, Valderas JM. Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire. Health expectations : an international journal of public participation in health care and health policy. 2017;20(5):961-72.
12. Ricci-Cabello I, Reeves D, Bell BG, Valderas JM. Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach. BMJ quality & safety. 2017;26(11):899-907.
13. Ricci-Cabello I, Marsden KS, Avery AJ, Bell BG, Kadam UT, Reeves D, et al. Patients’ evaluations of patient safety in English general practices: a cross-sectional study. The British journal of general practice : the journal of the Royal College of General Practitioners. 2017;67(660):e474-e82.
14. Ricci-Cabello I, Pons-Vigués M, Berenguera A, Pujol-Ribera E, Slight SP, Valderas JM. Patients’ perceptions and experiences of patient safety in primary care in England. Family practice. 2016;33(5):535-42.
15. Ricci-Cabello I, Avery AJ, Reeves D, Kadam UT, Valderas JM. Measuring Patient Safety in Primary Care: The Development and Validation of the “Patient Reported Experiences and Outcomes of Safety in Primary Care” (PREOS-PC). Annals of family medicine. 2016;14(3):253-61.
16. Ricci-Cabello I, Gonçalves DC, Rojas-García A, Valderas JM. Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments. Family practice. 2015;32(1):106-19.

SinergiAPS is the result of support from multiple funding agencies, both national, international, and regional.

• Evaluation of SINERGIAPS, an intervention aimed at improving patient safety in health centers in Spain based on the perceptions and experiences of the patients themselves: Hybrid clinical trial type I. Total: €223,850. Principal Investigator Coordinator: Ignacio Ricci Cabello. Period: 01/01/2023 to 31/12/2025.
• Development and Evaluation of an Intervention based on the provision of Patient Feedback to Improve Patient Safety in Spanish Primary Care Centres. Funding Agency: Instituto de Salud Carlos III. Total: €86,050. Principal Investigator: Ignacio Ricci Cabello. Period: 01/01/2018 to 01/09/2021.
• Translation and Validation of the PREOS-PC Questionnaire into Catalan.
  Funding Agency: Primary Care Management of Mallorca. Total: €2,000. Principal Investigator: María Jesús Serrano Ripoll, IdISBa. Period: 01/01/2019 – 01/01/2020.
• The development of an online patient safety questionnaire for primary care.
  Funding Agency: “East Midlands and West Midlands Academic Health Science Networks”, United Kingdom. Total: £68,144.00. Principal Investigator: Prof. Tony Avery, University of Nottingham (United Kingdom). Period: 1/10/2017 – 30/6/2019.
• Developing, testing and implementing the NSPCR Patient Safety Toolkit in general practices in England.
  Funding Agency: School for Primary Care Research, National Institute for Health Research, UK. Total: £569,740.00. Principal Investigator: Prof. Tony Avery, University of Nottingham (United Kingdom). Period: 1/10/2011 – 31/12/2013.