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Patient Safety and Quality

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Long waits for providers and lack of access are the most common frustrations among urban primary care patients

As part of a series of focus groups, adult patients indicate that primary care could be improved and made safer by boosting timely access to the patients' own physicians, shortening the time patients spend in waiting rooms, and adding staff to double-check prescriptions. Long waits for providers and lack of access (for example, waiting several months for an appointment or difficulty contacting providers for urgent problems) were the most common frustrations cited in the groups. Participants also cited understaffing, underfunding (for example, for health education and language translation), and lack of health insurance as contributing to poor quality of care.

In a study supported by the Agency for Healthcare Research and Quality (HS11955), researchers conducted 3 focus groups in 3 cities with 21 ethnically diverse patients (7 in each group) from 3 primary care clinics. Group discussions focused on what constituted good quality primary care and how the patients evaluated their own primary care. All but 2 percent of 187 distinct comments made during focus group discussions could be grouped into 4 categories: systems issues (44 percent of comments), interpersonal skills (37 percent), knowledge and technical skills (9 percent), and errors (7 percent).

Participants valued physician listening skills and felt that patient attitudes affected care. They also mentioned concern about medication errors, errors of inattention, and technical errors. Patients spontaneously identified several complex systems issues, including time issues, coordination of care, system resources, and the effects of insurance and financial status on services received. While patients expressed frustration with systems issues, they also showed understanding of the complex factors that create frustrating conditions. The groups also confirmed the importance of physician and staff interpersonal interactions with patients on quality of care.

See "Urban outpatient views on quality and safety in primary care," by Deborah Dowell, M.D., Linda Baier Manwell, M.S., Ann Maguire, M.D., M.P.H., and others in the Longwoods Review 3(1), pp. 2-8, 2005.

Editor's note: A related article describes the quality improvement process based on understanding primary care practices as complex adaptive systems. For more details, see Stroebel, C.K., McDaniel Jr., R.R., Crabtree, B.F., and others (2005, August). "How complexity science can inform a reflective process for improvement in primary care practices." Journal on Quality and Patient Safety 31(8), pp. 438-446.

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