Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

Abstract

Objective: To explore how patients, that had experienced harm in primary care, and how primary providers and practice managers understood reasons for harm and possibilities to reduce risk of harm. Design: Inductive qualitative analysis of structured questionnaires with free text answers. Setting: Primary health care in Sweden. Patients/subjects: Patients (n ¼ 22) who had experienced preventable harm in primary health care, and primary care providers and practice managers, including 15 physicians, 20 nurses and 24 practice managers. Main outcome measures: Categories and overarching themes from the qualitative analysis. Results: The three categories identified as important for safety were continuity of care, communication and competence. With flaws in these, risks were thought to be greater and if these were strengthened the risks could be reduced. The overarching theme for the patient was the experience of being neglected, like not having been properly examined. The overarching theme for primary care providers and practice managers was lack of continuity of care. Conclusion: Primary care providers, practice managers and patients understood the risks and how to reduce the risks of patient safety problems as related to three main categories: continuity of care, communication and competence. Future work towards a safer primary health care could therefore benefit from focusing on these areas. KEY POINTS Current awareness: Patients and primary care providers are rather untapped sources of knowledge regarding patient safety in primary health care. Main statements: Patients understood the risk of harm as stemming from that they were not properly examined. Primary care providers understood the risk of harm to a great extent as stemming from poor continuity of care. Patients, primary care providers and practice managers believed continuity, communication and competence play an important role in reducing risks.

Segurança do paciente: representações sociais na visão dos profissionais da atenção primária à saúde

“…Os profissionais investigados no presente estudo perceberem a importância de implementar a segurança do paciente no serviço de saúde, garantindo uma assistência contínua e de qualidade. Os usuários também identificam essa importância, conforme atesta uma pesquisa (29) realizada na Suécia, que destacou as percepções dos pacientes sobre o risco de dano na atenção primária à saúde, possuindo como fatores relevantes: a continuidade do atendimento, pois quando o cuidado torna-se fragmentado compreendem que aumentam o risco para a saúde do paciente; as rotinas de acompanhamento, devido aos pacientes se sentirem responsáveis para que o acompanhamento aconteça; o envolvimento do paciente, pois quando é baixo, dificulta o acesso ao serviço e diagnóstico precoce; a presença de erros, como na dosagem de medicamentos; o atendimento não qualificado, ou seja, o profissional demonstrou dúvidas, não realizando anamnese e exame físico detalhado.…”

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

“…The surveys used in this study were constructed using a qualitative analysis of HCPs' understanding of safety risks and ways to mitigate those risks in PHC, increasing the surveys' relevance [13]. 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.…”

“…However, it is still unknown what contributing factors or risks are considered important for mitigation from both health care professionals' (HCPs') and patients' perspectives. Our group has earlier conducted a qualitative study to identify factors important for understanding risks and solutions for patient safety issues in PHC [13]. These results were used in the present study to guide the design of the surveys for HCPs and patients.…”

Sociological Study Results of Self-Assessment Possibilities for Self-Realization Among Doctors Of General Practice – Family Medicine in Ukraine

“…The affordability of health care, which has always been a national policy priority, is first of all realized through rendering primary medical care. The experience of the developed countries in the world demonstrates the proven economical and medical efficiency of primary medical care development based on the family medicine principles [1][2][3][4][5].…”