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Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach
  1. Ignacio Ricci-Cabello1,
  2. David Reeves2,
  3. Brian G Bell3,
  4. Jose M Valderas4
  1. 1 Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  3. 3 Primary Care, University of Nottingham, Nottingham, UK
  4. 4 NIHR PenCLAHRC and Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
  1. Correspondence to Dr Ignacio Ricci-Cabello, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK; nacho.ricci.cabello{at}


Objective To identify patient and family practice characteristics associated with patient-reported experiences of safety problems and harm.

Design Cross-sectional study combining data from the individual postal administration of the validated Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire to a random sample of patients in family practices (response rate=18.4%) and practice-level data for those practices obtained from NHS Digital. We built linear multilevel multivariate regression models to model the association between patient-level (clinical and sociodemographic) and practice-level (size and case-mix, human resources, indicators of quality and safety of care, and practice safety activation) characteristics, and outcome measures.

Setting Practices distributed across five regions in the North, Centre and South of England.

Participants 1190 patients registered in 45 practices purposefully sampled (maximal variation in practice size and levels of deprivation).

Main outcome measures Self-reported safety problems, harm and overall perception of safety.

Results Higher self-reported levels of safety problems were associated with younger age of patients (beta coefficient 0.15) and lower levels of practice safety activation (0.44). Higher self-reported levels of harm were associated with younger age (0.13) and worse self-reported health status (0.23). Lower self-reported healthcare safety was associated with lower levels of practice safety activation (0.40). The fully adjusted models explained 4.5% of the variance in experiences of safety problems, 8.6% of the variance in harm and 4.4% of the variance in perceptions of patient safety.

Conclusions Practices’ safety activation levels and patients’ age and health status are associated with patient-reported safety outcomes in English family practices. The development of interventions aimed at improving patient safety outcomes would benefit from focusing on the identified groups.

  • Adverse events, epidemiology and detection
  • General practice
  • Health services research
  • Medical error, measurement/epidemiology
  • Patient safety

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  • Contributors All authors were involved in the conception and design of the study. BB conducted the statistical analyses under the supervision of DR. IRC drafted the manuscript. All authors were involved in the interpretation of the data, contributed towards critical revision of the manuscript and approved the final draft. JMV had full access to all of the data and had final responsibility for the decision to submit for publication. JMV is the guarantor of this work.

  • Funding This research is part-funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval University of Nottingham ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement PREOS-PC data are available under request to the study guarantor.