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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


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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