Identifying Hazards in Primary Care

Abstract

Background: The wide-reaching, complex, understudied primary care environment presents hazards to patient safety. Elderly patients visit physician offices more often, with more problems, while taking more medications – increasing the complexity of the visit and the frequency of the hazards. Objective: Identify hazards in the primary care of elderly patients from the patient’s perspective. Methods: Fourteen elderly patients in three focus groups with questions developed from 70 hours of direct observation. Hazards were coded from participant responses and ‘what-if’ analyses to capture both explicit and implicit hazards. Results: Thematic hazard analysis resulted in eight emergent, overlapping hazard themes: 1) fragmentation of care; 2) problems with information transfer between healthcare professionals; 3) problems with patient communication and feedback; 4) problems with paper and electronic health records; 5) medication management and expense; 6) physical and memory limitations; 7) reliance on others; and 8) delays and difficulties accessing care. Hidden hazards, not recognized by the patients or those caring for them, were identified and require further exploration.