Global Research Priorities to Better Understand the Burden of Iatrogenic Harm in Primary Care: An International Delphi Exercise

Abstract

Using a modified Delphi exercise, Aziz Sheikh and colleagues identify research priorities for patient safety research in primary care contexts. Please see later in the article for the Editors' Summary

How safe is primary care? A systematic review

“…Furthermore, the overall volume of people using primary care is substantially higher than those using hospital services in many parts of the world, so even if incidents occur in a lower proportion of visits, this translates into a considerable burden of potential harm, though most is not severe 77. However, incidents occur in all care settings so this finding is only useful if it prompts policy-makers and clinicians to do something about it 78. Better prediction tools and more experimental studies are needed to understand which incidents we can avoid, and how best to do so.…”

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

“…3,5 Primary care poses unique challenges for the design of better-quality systems of care delivery. 3,5,6 Given the different case-mix considerations and the approach to care provision between hospitals and general practice, the ability to transfer lessons to primary care from efforts in hospital settings is limited. 5 Challenges facing modern primary care could also inadvertently create greater risks of health care-related harm; for example, patients are discharged from hospital earlier than before, and receive episodic and decentralised care; clinicians prescribe and monitor high-risk drugs; consultations are time-pressured; and continuity of care relies on co-ordination between many care providers and services.…”

“…20 Given the similarities of challenges faced by primary care services in developed nations identified by an international Delphi consensus study, a detailed analysis of (to our knowledge) the largest repository of general practice safety incidents could support action in priority areas of patient safety in primary care. 6 …”

Safety Incidents in the Primary Care Office Setting

“…5 Although children account for 40% of family physicians' workload, little is known about the safety of care delivered to children in the community setting. 6,7 In the United Kingdom, family practice is usually the patient's first point of contact with the health care service; most health care encounters occur in this setting, and it acts as a gateway to acute and specialist hospital-based services.…”