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Beliefs and experiences can influence patient participation in handover between primary and secondary care—a qualitative study of patient perspectives
  1. Maria Flink1,2,
  2. Gunnar Öhlén3,4,
  3. Helen Hansagi5,
  4. Paul Barach6,7,
  5. Mariann Olsson1,2
  1. 1Department of Neurobiology, Care Sciences and Society, Division of Social Work, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
  3. 3Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
  5. 5Department of Clinical Neuroscience, Division of Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
  6. 6Center for Patient Safety, Department of Anesthesia, Utrecht University Medical Center, Utrecht, Netherlands
  7. 7Department of Health Studies, University of Stavanger, Stavanger, Norway
  1. Correspondence to Maria Flink, Department of Neurobiology, Care Sciences and Society, Division of Social Work, Karolinska University Hospital, Kuratorskliniken B44, Huddinge, S-14186 Stockholm, Sweden; maria.flink{at}


Background Communication between healthcare settings at patient transfers between primary and secondary care, ‘handover’, is a critical and risky process for patients. Patients’ views on their roles in these processes are often lacking despite the knowledge that patient participation contributes to enhanced safety and wellbeing.

Objective This study aims to improve the knowledge and understanding of patients’ perspectives about their participation in handover.

Methods Twenty-three Swedish patients with chronic diseases were individually interviewed about their experiences with handovers between three clinical microsystems: emergency room, emergency ward and primary healthcare centres. Data were analysed using inductive qualitative content analysis.

Results Patients participated within the microsystems by exchanging information, and between microsystems by making contact with and conveying information to their next healthcare provider. Enablers for participation included positive encounters with providers, patient empowerment and beliefs about organisational factors. Patients’ trust in their providers, and providers’ attitudes were important factors in patients’ willingness to communicate. Patients who thought medical records access was shared across microsystems volunteered less information to their providers. Patients with experiences of non-effective handovers took more responsibility in the handover to ensure continuity of care.

Conclusions Patients participate actively in handovers when they feel a need for involvement to ensure continuity of care, and are less active when they perceive that their contribution is unnecessary or not valued. In acute care settings with short hospital stays and less time to establish a trusting relationship between patients and their providers, discharge encounters may be important enablers for patient engagement in handovers. The advantages of a redundant handover process need to be considered.

  • Emergency department
  • Patient-centred care
  • Primary care
  • Qualitative research
  • Transitions in care

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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