A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

Abstract

Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.

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

“…Patients reported changing their role as recipients of health care, and instead proactively spoke up, sought a second opinion or requested timely test results. There is a growing interest in increasing patient activation to achieve safer health care, and our findings support the idea that higher patient involvement is feasible, acceptable by patients, and perceived by them as an important strategy for harm prevention. Some patients who experienced safety problems changed their health‐care‐seeking behaviour toward the avoidance of unnecessary exposure to health care.…”

“…Finally, practices may be heterogeneous in terms of the areas they need to improve to deliver safer health care (eg, some practices may be perceived to provide excellent patient‐centred care, but struggle to offer timely appointments, or vice versa). The use of standardized and validated patient reported instruments, such as the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS‐PC) questionnaire, might prove a valuable resource for practices in order to help them identify and prioritize areas for safety improvement.…”

“…Most of the research conducted so far in the area of primary care patient safety is based on information supplied by health‐care providers, and limited attention has been paid to patients’ perspectives . Patients are the common element across the various settings, organizations and health professionals usually involved in their health care, and therefore, they are ideally suited to reflect on the health care they receive.…”

The global burden of diagnostic errors in primary care

“…11 Recent work has framed the diagnostic process along five process dimensions all of which must be considered in understanding diagnostic error. 12 These dimensions include (1) the patient-provider encounter (history, exam, ordering tests/referrals based on appropriate assessment); (2) performance and interpretation of diagnostic tests; (3) follow-up and tracking of diagnostic information (such as abnormal tests) over time; (4) subspecialty and referral-related communication and coordination issues; and (5) patient behaviours, adherence and engagement. All five process dimensions are vulnerable to breakdowns in primary care, and sometimes more than one dimension is involved in an error.…”

Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach

“…Evidence about the factors that can determine their occurrence is, however, very sparse 4. An increased risk of experiencing safety problems and harm may be associated with both patient clinical characteristics (such as the complexity5 of their conditions or of their therapeutic regimens) and practice characteristics (such as staffing or the practice meeting other criteria for quality of care).…”