ArticleAge and ageing2017
Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports.
Article in Age and ageing, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 58 citations in OpenAlex.
- Review
- Safety issues in post-discharge care of older patients in general practice: an ethnographic study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Article
- Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study.JMIR formative research · 2024Article
- Analysis of applying a patient safety taxonomy to patient and clinician-reported incident reports during the COVID-19 pandemic: a mixed methods study.BMC medical research methodology · 2023Article
- Defining avoidable healthcare-associated harm in prisons: A mixed-method development study.PloS one · 2023Article
- Experience of Combined Procedure during Percutaneous LAA Closure.Journal of clinical medicine · 2022Article
- Patients' perception of safety climate in Irish general practice: a cross-sectional study.BMC family practice · 2021Article
- A Mixed-Methods Analysis of Medication Safety Incidents Reported in Neonatal and Children's Intensive Care.Paediatric drugs · 2021Article
- Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England.BMJ open · 2021Article
- Nobody ever questions-Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative.PloS one · 2021Article
- Implementation of Computerized Physician Order Entry in Primary Care: A Scoping Review.Journal of multidisciplinary healthcare · 2021Article
- Looking for the "Little Things": A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource.Geriatrics (Basel, Switzerland) · 2020Article
- Perceived barriers to medical leadership training and methods to mitigate them in the undergraduate medical curriculum: A mixed-methods study of final-year medical students at two medical schools.Future healthcare journal · 2020Article
- Making hospital discharge safer for frail older patients.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- Addressing safety risks in integrated care programs for older people living at home: a scoping review.BMC geriatrics · 2020Article
- Patient-related factors associated with an increased risk of being a reported case of preventable harm in first-line health care: a case-control study.BMC family practice · 2020Article
- Diagnostic error in the emergency department: learning from national patient safety incident report analysis.BMC emergency medicine · 2019Article
- Identifying 'avoidable harm' in family practice: a RAND/UCLA Appropriateness Method consensus study.BMC family practice · 2019Article
- Validation of the Primary Care Patient Measure of Safety (PC PMOS) questionnaire.BMJ quality & safety · 2019Article
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
Background: older adults are frequent users of primary healthcare services, but are at increased risk of healthcare-related harm in this setting. Objectives: to describe the factors associated with actual or potential harm to patients aged 65 years and older, treated in primary care, to identify action to produce safer care. Design and Setting: a cross-sectional mixed-methods analysis of a national (England and Wales) database of patient safety incident reports from 2005 to 2013. Subjects: 1,591 primary care patient safety incident reports regarding patients aged 65 years and older. Methods: we developed a classification system for the analysis of patient safety incident reports to describe: the incident and preceding chain of incidents; other contributory factors; and patient harm outcome. We combined findings from exploratory descriptive and thematic analyses to identify key sources of unsafe care. Results: the main sources of unsafe care in our weighted sample were due to: medication-related incidents e.g. prescribing, dispensing and administering (n = 486, 31%; 15% serious patient harm); communication-related incidents e.g. incomplete or non-transfer of information across care boundaries (n = 390, 25%; 12% serious patient harm); and clinical decision-making incidents which led to the most serious patient harm outcomes (n = 203, 13%; 41% serious patient harm). Conclusion: priority areas for further research to determine the burden and preventability of unsafe primary care for older adults, include: the timely electronic tools for prescribing, dispensing and administering medication in the community; electronic transfer of information between healthcare settings; and, better clinical decision-making support and guidance.
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