Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study

Abstract

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals.Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided.Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data.Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation.Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

Sources of Conflict and Prevention Proposals in User Violence Toward Primary Care Staff: A Qualitative Study of the Perception of Professionals

“…Both studies coincide in the inappropriate use of the system due to the user's lack of knowledge, deficit in consultation times that generates conflict, the professionals' lack of communication skills, the users' misuse of emergencies, depersonalized treatment and deficit in the management of psychosocial problems in PC. Likewise, both parties also seem to agree on some proposals identified in our study, such as the creation of support groups to decongest waiting lists, professional training and more information for the user ( 29 ). These studies show the need to create preventive interventions in PC centers focused on the sources of conflict and the proposals for improvement shared by both users and professionals.…”

“…A recent study with PC users concluded that they positively value the changes in health care aimed at improving waiting times, comfort and the agility of procedures and bureaucracy. At the same time, they consider a source of conflict the lack of information on waiting times, the therapeutic process or the impersonal treatment by healthcare personnel ( 29 ). In short, the bibliography concludes that both education and training in the prevention and reduction of aggression are key aspects to address this problem.…”

Assessment of Non-physical User Violence and Burnout in Primary Health Care Professionals. The Modulating Role of Job Satisfaction

“…In this regard, women and PHC personnel with fewer years of professional experience report greater exposure to non-physical violence (8). Furthermore, a recent qualitative study has explored the causes of conflicts in Primary Care centers (40). The aspects that seem to cause most con?icts between users and professionals from an organizational point of view are the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, and the management of emergencies.…”

“…The aspects that seem to cause most con?icts between users and professionals from an organizational point of view are the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, and the management of emergencies. On the other hand, regarding the professionals, users pointed out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users (40). Among the alternatives proposed to reduce the conflict are the incorporation of specific support sta?…”

“…Among the alternatives proposed to reduce the conflict are the incorporation of specific support sta? for appointment management, the unloading of the administration service, the training of professionals in patient care and the incorporation of personnel specialized in psychosocial problems and the creation of support groups (40).…”