Development and piloting of a survey to estimate the frequency and nature of potentially harmful preventable problems in primary care from a UK patient's perspective

ASK ME!-Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey

Objective

Routine measurement of patient safety from the patients’ perspective receives increasing attention as an important component of safety measurement systems. The aim of this study was to examine patients’ experience with patient safety in ambulatory care and the results’ implications for routine patient safety measurement in ambulatory care.

Design

Cross-sectional mixed-mode survey.

Setting

General practitioner and specialist practices.

Participants

Patients aged >18 years seeking care in ambulatory care practices between February and June 2020.

Methods

A 22-item-questionnaire was completed in the practice or at home either on paper or online. Multivariate logistic regression was used to analyse the influence of survey mode and patient characteristics on patient experience with patient safety.

Results

The overall response rate was 71.1%. Most patients completed the questionnaire on site (76.6%) and on paper (96.1%). Between 30.1% to 68.5% of the respondents report the most positive option for patient experience with the main domains of patient safety. A total of 2.9% of patients reported having experienced a patient-safety event (PSE) during the last 12 months. Patients who filled in the questionnaire off site were more likely to report negative experiences for the scales communication & information (OR 1.2, 95% CI 1.0–1.5), rapport & participation (OR 1.4, 95% CI 1.1–1.7) and access (OR 1.3, 95% CI 0.9–1.4) than those who completed it on site. Those who chose a paper questionnaire were more likely to report negative experiences for all five scales compared to web responders.

Conclusion

Routine measurement of patient experience with factors contributing to the occurrence of PSEs can achieve high response rates by offering flexible participation options. Results gained from mixed-mode surveys need to take mode-effects into account when interpreting and using the results. Further research is needed in how to adequately assess number and type of experienced events in routine measurements.

Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study

OBJECTIVES

To evaluate patients' views on the content and use of the 'Five Moments for Medication Safety' materials developed as part of the WHO's 'Medication Without Harm' Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication.

METHODS

Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ², Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age.

RESULTS

We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be 'quite' or 'very' useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ² test, p<0.01), with younger people preferring this format.

CONCLUSIONS

Patients' views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation.

Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain

OBJECTIVES

To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful.

DESIGN

Population-level survey.

SETTING

Great Britain.

PARTICIPANTS

A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016.

MAIN OUTCOME MEASURES

Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public.

RESULTS

3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful.

CONCLUSIONS

This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care.