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Patient and caregiver perspectives on causes and prevention of ambulatory adverse events: multilingual qualitative study
  1. Anjana E Sharma1,2,
  2. Amber S Tran1,
  3. Marika Dy2,3,
  4. Adriana L. Najmabadi1,
  5. Kristan Olazo2,3,
  6. Beatrice Huang4,
  7. Urmimala Sarkar2,3
  8. The PARTNRS Study Stakeholder Advisory Research Council
    1. 1Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
    2. 2Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco Department of Medicine, San Francisco, California, USA
    3. 3Division of General Internal Medicine Zuckerberg San Francisco General Hospital, University of California San Francisco Department of Medicine, San Francisco, California, USA
    4. 4Division of HIV, Infectious Disease, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco Department of Medicine, San Francisco, California, USA
    1. Correspondence to Dr Anjana E Sharma, Department of Family & Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA 94110, USA; anjana.sharma{at}ucsf.edu

    Abstract

    Context Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute when engaged in ambulatory AE review, focusing on under-resourced care settings.

    Methods We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants’ perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes.

    Findings The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects.

    Conclusions An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives.

    • Patient safety
    • Adverse events, epidemiology and detection
    • Primary care
    • Ambulatory care
    • Quality improvement

    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @AJSharmaMD

    • Collaborators The PARTNRS study Stakeholder Advisory Research Council (SARC) reviewed collected data, helped develop themes, and reviewed and edited the manuscript. SARC (2019–2023) comprised: Adeola Oni-Orisan MD PhD, Alexis Blueford, Amelia Johnson, Ana Vilma Aquino, Barbara Glassey, Celia Damaris Mendez, Forrest M Thompson, Isela Mosteiro RN, Jane Redmond, Judith Burns, Kathleen Noonan RN, Lydia Leung MD, Olevia Cox, Patrick McKenna, Robin Cotterhill, Roxie 'Blue' Harris (In memoriam, Rest in Peace and Power), Sandeep Bhullar, Sharon Kincaid and Shin-Yu Lee PharmD.

    • Contributors AES, the guarantor, conceived of the design, oversaw implementation, and led analysis and development of the manuscript. AST co-conducted analysis and co-conducted drafting of the manuscript. MD and KO co-conducted analysis. AN and BH co-conducted data collection and facilitated Stakeholder Advisory Research Council input. US guided overall project realisation and coauthored the manuscript.

    • Funding This study was funded by the National Institutes of Health (NIH) (KL2TR001870), National Cancer Institute (K24CA212294), Agency for Healthcare Research and Quality (K08HS028477).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.