Exploration of the nature and sources of harm in primary care based on patient-reported experiences: a mixed-methods cross-sectional study using data from the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire.

Problem

Identifying problems in healthcare provision leading to harm is critical to improve primary care patient safety. The aim of this study is to examine patient-reported experiences to explore the nature of harm and its contributing factors.

Approach

Mixed-methods study using cross-sectional data from 1,244 patients who completed the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire. The associations between the different types of safety problems and harm were explored quantitatively using hybrid structural equation models (19 fixed-response items), and qualitatively using inductive content analysis (five free-text items). Results from quantitative and qualitative analyses were triangulated to confirm and enrich our findings.

Findings

Three distinct types of harm emerged: emotional harm, pain, and physical harm. Emotional harm was mainly associated with problems with appointments (delayed); patient-provider communication (patients not felt listened/believed); and coordination between providers (e.g., lost referral letters) [β=0.15; 0.15; 0.14, respectively]. Pain was mainly associated with appointments (delayed, resulting in prolonged pain) and tests (problems with sample extraction) [0.07; 0.06]. Physical harm (the most severe in nature) was associated with diagnosis (wrong, missed, or delayed - leading to exacerbations) and treatment (delayed, wrong, adverse drug reactions) problems [0.10; 0.05]. Main factors associated with diagnosis problems were patient-provider communication [0.42] and coordination between providers [0.36]. Main factors associated with treatment problems were diagnosis [0.34] and tests problems [0.27].

Consequences

Patients can identify factors contributing to their adverse event. The PREOS-PC questionnaire could constitute a valuable resource for practices to inform safety improvement initiatives.