Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

Objective: To explore how patients, that had experienced harm in primary care, and how primary providers and practice managers understood reasons for harm and possibilities to reduce risk of harm. Design: Inductive qualitative analysis of structured questionnaires with free text answers. Setting: Primary health care in Sweden. Patients/subjects: Patients (n = 22) who had experienced preventable harm in primary health care, and primary care providers and practice managers, including 15 physicians, 20 nurses and 24 practice managers. Main outcome measures: Categories and overarching themes from the qualitative analysis. Results: The three categories identified as important for safety were continuity of care, communication and competence. With flaws in these, risks were thought to be greater and if these were strengthened the risks could be reduced. The overarching theme for the patient was the experience of being neglected, like not having been properly examined. The overarching theme for primary care providers and practice managers was lack of continuity of care. Conclusion: Primary care providers, practice managers and patients understood the risks and how to reduce the risks of patient safety problems as related to three main categories: continuity of care, communication and competence. Future work towards a safer primary health care could therefore benefit from focusing on these areas. Key points Current awareness: * Patients and primary care providers are rather untapped sources of knowledge regarding patient safety in primary health care. Main statements: * Patients understood the risk of harm as stemming from that they were not properly examined. * Primary care providers understood the risk of harm to a great extent as stemming from poor continuity of care. * Patients, primary care providers and practice managers believed continuity, communication and competence play an important role in reducing risks.