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

Abstract

BackgroundThere is a growing interest in identifying strategies to achieve safer primary health‐care provision. However, most of the research conducted so far in this area relies on information supplied by health‐care providers, and limited attention has been paid to patients’ perspectives.ObjectiveTo explore patients’ experiences and perceptions of patient safety in English general practices with the aim of eliciting patient‐centred recommendations for improving patient safety.MethodsThe Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire was sent to a random sample of 6736 primary care users registered in 45 English practices. We conducted a qualitative content analysis of responses to seven open‐ended items addressing patients’ experiences of safety problems, lessons learnt as a result of such experiences and recommendations for safer health care.ResultsA total of 1244 (18.4%) participants returned completed questionnaires. Of those, 678 (54.5%) responded to at least one open‐ended question. Two main themes emerged as follows: (i) experiences of safety problems and (ii) good practices and recommendations to improve patient safety in primary care. Most frequent experiences of safety problems were related to appointments, coordination between providers, tests, medication and diagnosis. Patients’ responses to these problems included increased patient activation (eg speaking up about concerns with their health care) and avoidance of unnecessary health care. Recommendations for safer health care included improvements in patient‐centred communication, continuity of care, timely appointments, technical quality of care, active monitoring, teamwork, health records and practice environment.ConclusionThis study identified a number of patient‐centred recommendations for improving patient safety in English general practices.

Frequency and nature of potentially harmful preventable problems in primary care from the patient’s perspective with clinician review: a population-level survey in Great Britain

“…Until recently, patients could not make reports directly to the NRLS. 21 22 A European survey in 2013 found that 43% of UK respondents felt that it was ‘likely’ that patients could be harmed by non-hospital healthcare and a recent survey of the UK public found that 21% of respondents reported experiencing a potentially harmful preventable problem in primary care within the past 12 months. 23 24 These surveys suggest large differences between patients and clinicians in their beliefs about potentially harmful problems in primary care, but this has not been examined at the population level.…”

Validation and initial results of surveys exploring perspectives on risks and solutions for diagnostic and medication errors in primary care in Sweden

“…Stakeholders’ priorities concerning patient safety problems and solutions have received little attention so far, especially regarding patients with experience of harm. Some studies have suggested interesting patient-centred recommendations for improving patient safety including patient-centred communication, timely appointments, active monitoring, teamwork and better work environment [ 28 ], but these suggestions did not specifically come from patients that had experienced harm in primary care. In our study, patients who had experienced harm considered lack of physician knowledge as a problem and wanted the doctor to examine them thoroughly, perhaps signalling a lack of trust in the outcome of the consultation.…”

“…Another strength of the study was that it included patients that had experienced preventable harm in the form of diagnostic error or medication error in primary health care giving their perspective on risks and solutions. Earlier studies have asked patients in general, not patients that have been subject to harm [ 28 , 32 ].…”

Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

“…These incidents are frequently related to diagnosis (either delayed or missed) or to treatment (delayed or inappropriate) [4,5]. A number of different factors contribute to these incidents, such as the working environment, information transfer at the primary-secondary interface, doctor-patient relationship or continuing education [6][7][8].…”