Improving communication to reduce risks to patient safety: what are the barriers and enablers for older people with multimorbidity?
Older people with multimorbidity are likely to experience more patient safety incidents. In primary care, threats to patient safety often arise as a result of breakdowns in communication between patients and staff. Thus, interventions to improve communication could help reduce risks to patient safety. Such interventions are commonly aimed at staff. However, some important aspects of communication are patient- as opposed to provider-initiated. Previous research has demonstrated patients can be empowered to communicate more effectively but this work has not been carried out with older people with multimorbidity. Prior to designing and testing such an intervention, we first aim to develop a better understanding of the barriers to and enablers of communication in primary care for this patient population, as well as what might need to change for communication to improve.
In-depth interviews are being carried out with a stratified sample of older people with multimorbidity and a range of clinical and administrative staff from general practices. The interviews explore experiences of communication by asking about recent interactions and any communication problems that have occurred. The schedule also includes prompts based on the COM-B model of behaviour. These are designed to further explore barriers and enablers, and how patients could be supported to communicate more effectively.
Older people with multimorbidity face many barriers to communication in primary care, and respond to these in different ways. Whether or not communication happens and how effective it is appears to be determined by the interplay between a number of factors. These include patient knowledge and confidence, practice policies and environment, and the perceived friendliness and approachability of staff. Patients would like or be receptive to learning more about their General Practices, and when and how best to interact with them. If available, they would also make use of tools to help them prepare for appointments and ensure they raise their concerns. However, patients prefer to avoid rather than provide feedback to staff they feel are not personable or interested in them.
Our findings suggest patients learn how to communicate with primary care staff through experience but, in many cases, such learning could be provided proactively. Empowering patients to communicate more effectively could help them avoid or better address communication problems. This, in turn, could reduce risks to patient safety.Findings from this study will be used to inform the development of a patient-centred behaviour change intervention. Whilst many aspects of this could be standardised (such as communication tools), it is likely that some elements will need to be tailored to individual practices (for example, information on staff and services). It will not be possible to address all of the identified barriers without adding a staff-centred component.