Patient Reports Of Preventable Problems And Harms In Primary Health Care
adverse events; ecology; General & Internal Medicine; harms; health care; medical errors; patient perspective; patient safety; patient-centered care; physician-patient relations; physicians; qualitative research; quality; quality assurance; safety
BACKGROUND Despite recent attention given to medical errors, little is known about the kinds and importance of medical errors in primary care. The principal aims of this study were to develop patient-focused typologies of medical errors and harms in primary care settings and to discern which medical errors and harms seem to be the most important. METHODS Thirty-eight in-depth anonymous interviews of adults from rural, suburban, and urban locales in Virginia and Ohio were conducted to solicit stories of preventable problems with primary health care that led to physical or psychological harm. Transcriptions were analyzed to identify, name, and organize the stories of errors and harms. RESULTS The 38 narratives described 221 problematic incidents that predominantly involved breakdowns in the clinician-patient relationship (n = 82, 37%) and access to clinicians (n = 63, 29%). There were several reports of perceived racism. The incidents were linked to 170 reported harms, 70% of which were psychological, including anger, frustration, belittlement, and loss of relationship and trust in one's clinician. Physical harms accounted for 23% of the total and included pain, bruising, worsening medical condition, and adverse drug reactions. DISCUSSION The errors reported by interviewed patients suggest that breakdowns in access to and relationships with clinicians may be more prominent medical errors than are technical errors in diagnosis and treatment. Patients were more likely to report being harmed psychologically and emotionally, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook other patient priorities.
Kuzel A J; Woolf S H; Gilchrist V J; Engel J D; LaVeist T A; Vincent C; Frankel R M
Annals of Family Medicine
2004
2004-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1370/afm.220" target="_blank" rel="noreferrer noopener">10.1370/afm.220</a>
Making The Case For A Qualitative Study Of Medical Errors In Primary Care
adverse events; australian health-care; aviation; Biomedical Social Sciences; doctor; harm; hospitalized-patients; Information Science & Library Science; lessons; medical error; needs; patient harms; patient perspectives; preferences; qualitative methods; records; Social Sciences - Other Topics
In the interest of publicizing examples of funded qualitative health research, the authors share a proposal to the Ageney for Healthcare Research and Quality in Washington, D.C., in which they sought to elicit patient stories of preventable problems in their primary health care that were associated with psychological or physical harms. These stories would allow for the construction of a tentative typology of errors and harms as experienced by patients and the contrasting of this with errors and harms reported by primary care physicians in the United States and other countries. The authors make explicit the anticipated concerns of reviewers more accustomed to quantitative research proposals and the arguments and strategies employed to address them.
Kuzel A J; Woolf S H; Engel J D; Gilchrist V J; Frankel R M; LaVeist T A; Vincent C
Qualitative Health Research
2003
2003-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/1049732303255657" target="_blank" rel="noreferrer noopener">10.1177/1049732303255657</a>