Where next for primary care patient safety? A James Lind Alliance prioritisation setting partnership

Problem

As the majority of contacts within the UK healthcare services occur within primary care, the opportunity for patient safety incidents to occur is significant. Despite this primary care patient safety has been under researched and underfunded. Increasingly there is a recognition of the need to examine patient safety within a primary care setting but as resources available for research are limited it is important to address research questions that matter to those who use the services. The James Lind Alliance (JLA) is a priority setting approach to identify the most important areas for research that has become well established in the UK. The JLA is overseen by the National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC). Its aim is to provide opportunities for patients and healthcare professionals to work together to agree what are the most important treatment uncertainties affecting an area, in order to influence the prioritisation of future research in that area. This partnership aimed to identify the top 10 unanswered research questions for primary care patient safety research.

Approach

The JLA priority setting partnership adopts a structured approach to the identification of unanswered questions, or uncertainties, and their prioritisation. A national survey of patients, carers, general practitioners, pharmacists, nurses, dentists, other allied health care professionals, patients, and carers was conducted. Questions were then processed from their raw form with similar questions combined into indicative questions. These questions were then categorised and refined into research questions and the literature was searched to identify any relevant evidence. A second national prioritisation exercise was then conducted on unanswered questions and the priority questions were taken forward to a final prioritisation workshop where the top 10 questions were identified by patients, carers and primary care health care staff.

Findings

443 research questions were submitted by 351 patients and 86 healthcare professionals. After checking for relevance and rephrasing, a total of 173 questions were collated into themes. The themes were largely focused on communication, team and system working, interfaces across primary and secondary care, medication, self-management support and technology. After the second national prioritisation exercise, the top 30 questions were taken forward to the final prioritisation workshop. The top 10 research questions prioritised in the final workshop will be presented.

Consequences

The top 10 research questions identified a range of systems of care where there are outstanding questions to address in primary care patient safety research. The final top 10 research priorities will be used to guide funding of primary care patient safety research over the next 5-10 years on areas that are important to both patients and healthcare professionals to address questions that are needed in practice.