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Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Quality and safety issues highlighted by patients in the handling of laboratory test results by general practices–a qualitative study

Authors: David Edward Cunningham, Duncan McNab, Paul Bowie

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

In general practice internationally, many care teams handle large numbers of laboratory test results relating to patients in their care. Related research about safety issues is limited with most of the focus on this workload from secondary care and in North American settings. Little has been published in relation to primary health care in the UK and wider Europe. This study aimed to explore experiences and perceptions of patients with regards to the handling of test results by general practices.

Methods

A qualitative research approach was used with patients. The setting was west of Scotland general practices from one National Health Service territorial board area. Patients were purposively sampled from practice held lists of patients who received a number of laboratory tests because of chronic medical problems or surveillance of high risk medicines. Focus groups were held and were audio-recorded. Tapes were transcribed and subjected to qualitative analysis. Transcripts were coded and codes merged into themes by two of the researchers.

Results

19 participants from four medical practices took part in four focus groups. The main themes identified were: 1. Patients lacked awareness of the results handling process in their practice. 2. Patients usually did not contact their practice for test results, unless they considered themselves to be ill. 3. Patients were concerned about the appropriateness of administrators being involved in results handling. 4. Patients were concerned about breaches of confidentiality when administrators were involved in results handling. 5. Patients valued the use of dedicated results handling staff. 6. Patients welcomed the use of technology to alert them to results being available, and valued the ability to choose how this happened.

Conclusions

The study confirms the quality and safety of care problems associated with results handling systems and adds to our knowledge of the issues that impact in these areas. Practices need to be aware that patients may not contact them about results, and they need to publicise their results handling processes to patients and take steps to reassure patients about confidentiality with regards to administrators.
Literature
2.
go back to reference Scottish Government Social Research: An Overview of Evidence Relating to Shifting the Balance of Care: A Contribution to the Knowledge Base. 2008, Edinburgh, Scotland: The Scottish Government Scottish Government Social Research: An Overview of Evidence Relating to Shifting the Balance of Care: A Contribution to the Knowledge Base. 2008, Edinburgh, Scotland: The Scottish Government
3.
go back to reference The Scottish Government: A Route Map to the 2020 Vision for Health and Social Care. 2012, Edinburgh: The Scottish Government The Scottish Government: A Route Map to the 2020 Vision for Health and Social Care. 2012, Edinburgh: The Scottish Government
4.
go back to reference Patterson E, Forrester K, Price K, Hegney D: Risk reduction in general practice and the role of the receptionist. J Law Med. 2005, 12 (3): 340-347.PubMed Patterson E, Forrester K, Price K, Hegney D: Risk reduction in general practice and the role of the receptionist. J Law Med. 2005, 12 (3): 340-347.PubMed
5.
go back to reference Swinglehurst D, Greenhalgh T, Russell J, Mayall M: Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. Br Med J. 2011, 343: d6788-10.1136/bmj.d6788.CrossRef Swinglehurst D, Greenhalgh T, Russell J, Mayall M: Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. Br Med J. 2011, 343: d6788-10.1136/bmj.d6788.CrossRef
6.
go back to reference Hammond J, Gravenhorst K, Funnell E, Beatty S, Hibbert D, Lamb J, Kovandzic M, Gabbay M, Dowrick C, Gask L, Waheed W, Chew-Graham CA: Slaying the dragon myth: an ethnographic study of receptionists in UK general practice. Br J Gen Pract. 2013, 63: e177-e184.CrossRefPubMedPubMedCentral Hammond J, Gravenhorst K, Funnell E, Beatty S, Hibbert D, Lamb J, Kovandzic M, Gabbay M, Dowrick C, Gask L, Waheed W, Chew-Graham CA: Slaying the dragon myth: an ethnographic study of receptionists in UK general practice. Br J Gen Pract. 2013, 63: e177-e184.CrossRefPubMedPubMedCentral
7.
go back to reference Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW: “I wish I had seen this earlier!” Dissatisfaction with test result managment in primary care. Arch Intern Med. 2004, 164: 2223-2228. 10.1001/archinte.164.20.2223.CrossRefPubMed Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW: “I wish I had seen this earlier!” Dissatisfaction with test result managment in primary care. Arch Intern Med. 2004, 164: 2223-2228. 10.1001/archinte.164.20.2223.CrossRefPubMed
8.
go back to reference Hickner J, Graham DG, Elder NC, Brandt E, Emsermann CB, Dovey S, Phillips R: Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of family physicians national research network. Qual Safety Health Care. 2008, 17: 194-200. 10.1136/qshc.2006.021915.CrossRef Hickner J, Graham DG, Elder NC, Brandt E, Emsermann CB, Dovey S, Phillips R: Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of family physicians national research network. Qual Safety Health Care. 2008, 17: 194-200. 10.1136/qshc.2006.021915.CrossRef
9.
go back to reference Vincent C, Davy C, Esmail A, Neale G, Elstein M, Cozens JF, Walshe K: Learning from litigation: an analysis of claims for clinical negligence. 2004, Manchester: Victoria University of Manchester Vincent C, Davy C, Esmail A, Neale G, Elstein M, Cozens JF, Walshe K: Learning from litigation: an analysis of claims for clinical negligence. 2004, Manchester: Victoria University of Manchester
10.
go back to reference Callen J, Georgiou A, Li J, Westbrook JI: The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Safety. 2011, 11 (20): 194-199.CrossRef Callen J, Georgiou A, Li J, Westbrook JI: The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Safety. 2011, 11 (20): 194-199.CrossRef
11.
go back to reference Roy CL, Poon EG, Karson AS, Ladak-Merchant Z, Johnson RE, Maviglia SM, Gandhi TK: Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005, 143: 121-128. 10.7326/0003-4819-143-2-200507190-00011.CrossRefPubMed Roy CL, Poon EG, Karson AS, Ladak-Merchant Z, Johnson RE, Maviglia SM, Gandhi TK: Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005, 143: 121-128. 10.7326/0003-4819-143-2-200507190-00011.CrossRefPubMed
12.
go back to reference Schwappach DLB: Engaging patients as vigilant partners in safety: a systematic review. Med Care Res Rev. 2010, 67: 119-10.1177/1077558709342254.CrossRefPubMed Schwappach DLB: Engaging patients as vigilant partners in safety: a systematic review. Med Care Res Rev. 2010, 67: 119-10.1177/1077558709342254.CrossRefPubMed
13.
go back to reference Hrisos S, Thomson R: Seeing it from both sides: do approaches to involving patients in improving their safety risk damaging the trust between patients and healthcare professionals? An interview study. PLoS. 2013, 8 (11): e80759-10.1371/journal.pone.0080759.CrossRef Hrisos S, Thomson R: Seeing it from both sides: do approaches to involving patients in improving their safety risk damaging the trust between patients and healthcare professionals? An interview study. PLoS. 2013, 8 (11): e80759-10.1371/journal.pone.0080759.CrossRef
14.
go back to reference Doherty C, Stavropoulou C: Patients’ willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med. 2012, 75: 257-263. 10.1016/j.socscimed.2012.02.056.CrossRefPubMed Doherty C, Stavropoulou C: Patients’ willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med. 2012, 75: 257-263. 10.1016/j.socscimed.2012.02.056.CrossRefPubMed
15.
go back to reference Elder NC, Barney K: “But what does it mean for me?” Primary care patient’s communication preferences for test results notification. Jt Comm J Qual Improv Patient Safety. 2012, 38 (4): 168-176. Elder NC, Barney K: “But what does it mean for me?” Primary care patient’s communication preferences for test results notification. Jt Comm J Qual Improv Patient Safety. 2012, 38 (4): 168-176.
16.
go back to reference Elder NC, Graham D, Brandt E, Dovey S, Phillips R, Ledwith J, Hickner J: The testing process in family medicine: problems, solutions and barriers as seen by physicians and their staff. J Patient Safety. 2006, 2 (1): 25-32. Elder NC, Graham D, Brandt E, Dovey S, Phillips R, Ledwith J, Hickner J: The testing process in family medicine: problems, solutions and barriers as seen by physicians and their staff. J Patient Safety. 2006, 2 (1): 25-32.
17.
go back to reference Gandhi TK, Lee TH: Patient Safety beyond the Hospital. N Engl J Med. 2010, 363: 1001-1003. 10.1056/NEJMp1003294.CrossRefPubMed Gandhi TK, Lee TH: Patient Safety beyond the Hospital. N Engl J Med. 2010, 363: 1001-1003. 10.1056/NEJMp1003294.CrossRefPubMed
18.
go back to reference Hanna D, Griswold P, Leape LL, Bates DW: Communicating critical test results: safe practice recommendations. J Qual Patient Safety. 2005, 31 (2): 68-80. Hanna D, Griswold P, Leape LL, Bates DW: Communicating critical test results: safe practice recommendations. J Qual Patient Safety. 2005, 31 (2): 68-80.
19.
go back to reference Vincent CA, Coulter A: Patient safety: what about the patient?. Qual Safety Health Care. 2002, 11: 76-80. 10.1136/qhc.11.1.76.CrossRef Vincent CA, Coulter A: Patient safety: what about the patient?. Qual Safety Health Care. 2002, 11: 76-80. 10.1136/qhc.11.1.76.CrossRef
20.
go back to reference The Health Foundation: Evidence Scan: Involving patients in improving safety. 2013, London: The Health Foundation The Health Foundation: Evidence Scan: Involving patients in improving safety. 2013, London: The Health Foundation
22.
go back to reference Boyatzis RE: Transforming Qualitative Information: Thematic Analysis and Code Development. 1998, Thousand Oaks, USA: Sage Boyatzis RE: Transforming Qualitative Information: Thematic Analysis and Code Development. 1998, Thousand Oaks, USA: Sage
24.
go back to reference Scott K, Dyas JV, Middlemass JB, Siriwandena AN: Confidentiality in the waiting room: an observational study in general practice. Br J Gen Pract. 2007, 57: 490-493.PubMedPubMedCentral Scott K, Dyas JV, Middlemass JB, Siriwandena AN: Confidentiality in the waiting room: an observational study in general practice. Br J Gen Pract. 2007, 57: 490-493.PubMedPubMedCentral
25.
go back to reference Sokol D, Car J: Protecting patient confidentiality in telephone consultations in general practice. Br J Gen Pract. 2006, 56: 384-385.PubMedPubMedCentral Sokol D, Car J: Protecting patient confidentiality in telephone consultations in general practice. Br J Gen Pract. 2006, 56: 384-385.PubMedPubMedCentral
26.
27.
go back to reference Baldwin DM, Quintela J, Duclos C, Staton EW, Pace WD: Patient preference for notification of normal tests results: as report from the ASIPS collaborative. BMC Fam Pract. 2005, 6 (11). Baldwin DM, Quintela J, Duclos C, Staton EW, Pace WD: Patient preference for notification of normal tests results: as report from the ASIPS collaborative. BMC Fam Pract. 2005, 6 (11).
28.
go back to reference Sung S, Forman-Hoffman V, Wilson MC, Cram PM: Direct reporting of laboratory test results to patients by mail to enhance patient safety. J Gen Intern Med. 2006, 21: 1075-1078. 10.1111/j.1525-1497.2006.00553.x.CrossRefPubMedPubMedCentral Sung S, Forman-Hoffman V, Wilson MC, Cram PM: Direct reporting of laboratory test results to patients by mail to enhance patient safety. J Gen Intern Med. 2006, 21: 1075-1078. 10.1111/j.1525-1497.2006.00553.x.CrossRefPubMedPubMedCentral
31.
go back to reference Bowie P, Forrest E, Price J, Halley L, Cunningham D, Kelly M, McKay J: Expert consensus on safe laboratory test ordering and results management systems in European primary care. Eur J Gen Pract. 2014, in press Bowie P, Forrest E, Price J, Halley L, Cunningham D, Kelly M, McKay J: Expert consensus on safe laboratory test ordering and results management systems in European primary care. Eur J Gen Pract. 2014, in press
Metadata
Title
Quality and safety issues highlighted by patients in the handling of laboratory test results by general practices–a qualitative study
Authors
David Edward Cunningham
Duncan McNab
Paul Bowie
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-206

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