Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study
Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study
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DOI：
10.1136/bmjqs-2015-004049
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发表时间：
2015-09-01
影响因子：
5.4
通讯作者：
Dunbar, James A.
中科院分区：
文献类型：
--
作者：
Hernan, Andrea L.;Giles, Sally J.;Dunbar, James A.
患者在减少初级保健环境中的伤害方面发挥着重要作用。从患者经验和反馈中学习可以提高患者安全性。在很大程度上缺乏证据来捕捉病人对创造安全初级保健的各种促成因素的看法。本研究的目的是解决这个证据gap.Methods四个焦点小组和八个半结构化访谈进行了34例患者和照顾者从澳大利亚东南部。参与者被要求描述他们的初级保健经验。逐字转录录音，并使用约克郡贡献因素框架（YCFF）在分析中确定了导致安全事故的具体因素。从数据中出现的其他因素也被确定，并添加到分析框架。结果13个因素，有助于在初级保健安全事故被确定。初级保健环境的五个独特因素与医院环境中的YCFF中存在的八个因素一起被发现。五个独特的初级保健安全事故的影响因素代表了初级保健系统内的一系列水平，从当地的工作条件到上游组织层面和外部政策背景。这13个因素包括沟通、可及性、患者因素、外部政策背景、尊严和尊重、初级-次级接口、护理连续性、任务绩效、任务特征、咨询时间、安全文化，团队因素和物理环境。讨论患者和护理人员的这种类型的反馈可以帮助主要-护理专业人员更好地了解和确定潜在的安全问题，并作出适当的服务改进。确定的一系列综合因素为开发系统地捕获患者安全的多个促成因素的工具提供了基础。
Background Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap.Methods Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework.Results Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment.Discussion Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety.