Health Services & Policy Research Group, Patient Centred Care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
J Patient Saf. 2021 Jan 1;17(1):e20-e27. doi: 10.1097/PTS.0000000000000669.
The aim of the study was to identify the main factors leading to harm in primary care based on the experiences reported by patients.
We conducted a mixed-methods, cross-sectional study in 45 primary care centers in England. A random sample of 6736 patients was invited to complete the Patient-Reported Experiences and Outcomes of Safety in Primary Care questionnaire. We fitted structural equation modeling on the quantitative data (n = 1244 respondents) to identify contributory factors and primary incidents leading to harm. We conducted content analyses of responses to seven open-ended questions (n = 386) to obtain deeper insight into patient perceptions of the causes of harm experienced. Results from quantitative and qualitative analyses were triangulated.
Patients reported harm related to physical health (13%), pain (11%), and mental health (19%) and harm that increased limitations in social activities (14%). Physical harm was associated with incidents affecting diagnosis (β = 0.43; delayed and wrong), and treatment (0.12; delayed, wrong treatment, or dose), which were in turn associated with incidents with patient-provider communication, coordination between providers, appointments, and laboratory tests. Pain was associated with laboratory tests (0.21; caused when collecting blood or tissue samples) and with problems booking an appointment when needed (0.13; delaying treatment for pain). Harm to mental health was associated with incidents related to the following: diagnosis (0.28), patient-provider communication (0.18), appointments (0.17), coordination between different providers (0.14), and laboratory tests (0.12). Harm increasing limitations in social activities was associated with incidents related to diagnosis (0.42) and diagnostic and monitoring procedures (0.20).
Our findings suggest the need for patient-centered strategies to reduce harm in primary care focusing on the improvement of the quality of diagnosis and patient-provider communication.
本研究旨在根据患者报告的经验，确定导致初级保健中伤害的主要因素。
我们在英格兰的 45 个初级保健中心进行了一项混合方法、横断面研究。随机抽取 6736 名患者参加初级保健患者报告的安全性体验和结局调查问卷。我们对定量数据（n=1244 名受访者）进行结构方程建模，以确定导致伤害的促成因素和主要事件。我们对 7 个开放式问题的回答进行内容分析（n=386），以深入了解患者对所经历伤害原因的看法。对定量和定性分析的结果进行了三角剖分。
患者报告与身体健康（13%）、疼痛（11%）和心理健康（19%）相关的伤害以及增加社会活动受限的伤害（14%）。身体伤害与影响诊断（β=0.43；延迟和错误）和治疗（0.12；延迟、错误治疗或剂量）的事件有关，而这些事件又与医患沟通、提供者之间的协调、预约和实验室检查有关。疼痛与实验室检查（0.21；采集血液或组织样本时引起）和需要预约时出现的问题（0.13；延迟疼痛治疗）有关。心理健康受损与以下事件有关：诊断（0.28）、医患沟通（0.18）、预约（0.17）、不同提供者之间的协调（0.14）和实验室检查（0.12）。增加社会活动受限的伤害与诊断（0.42）和诊断和监测程序（0.20）有关的事件有关。
我们的研究结果表明，需要采取以患者为中心的策略，通过改善诊断质量和医患沟通，减少初级保健中的伤害。
