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From policy to patient : using a socio-ecological framework to explore the factors influencing safe practice in UK primary care
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Litchfield, Ian, Perryman, Katherine, Avery, Anthony, Campbell, Stephen, Gill, Paramjit and Greenfield, Sheila (2021) From policy to patient : using a socio-ecological framework to explore the factors influencing safe practice in UK primary care. Social Science & Medicine, 277 . 113906. doi:10.1016/j.socscimed.2021.113906 ISSN 0277-9536.
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WRAP-from-policy-patient-using-socio-ecological-framework-explore-factors-influencing-safe-practice-UK-primary-care-Gill-2021 .pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1698Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.socscimed.2021.113906
Abstract
Background:
The recent and rapid changes in the model of primary care delivery have led to an increased focus on patient safety in what is one of the most diverse and complex healthcare settings. However, previous initiatives have failed to deliver the expected improvements, leading to calls for a better understanding of how a range of personal and contextual factors influence the decisions and behaviours of individual care providers.
Methods:
The socio-ecological framework, successfully used in public health settings to interpret the complex influences on individual behaviours, enabled a post-hoc deductive analysis of a series of semi-structured interviews conducted with clinical staff and senior managers at a range of practices across five geographically diverse regions in England to explore their perspectives on the factors that influence safe practice.
Results:
The five levels of the socio-ecological framework successfully helped unpick the myriad influences on safe primary care practice, including, at the Individual level, assumptions of responsibility and previous experience; at the Interpersonal, equitable communication in support of a team ethos; at the Organisational, the physical infrastructure, size and complexity of the practice; at the Community, the health profile and literacy of patients; and at the Policy, meeting the demands of competing local and national governing bodies.
Conclusions:
Coherent, realistic and achievable goals are needed for improving patient safety in primary care addressing personal, organisational and environmental factors. Such goals and the tools and interventions designed to meet them must therefore be sympathetic to the demands on resources and the characteristics of patients, staff, and their organisations. Using the framework to interpret our findings provided much needed insight into the impact of these varying influences, and highlights the importance of recognising and communicating the relationship between specific contextual factors and the ability of individual providers to provide safe primary care.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
| Library of Congress Subject Headings (LCSH): | Primary care (Medicine), Medical policy -- Research, Health services administration -- Great Britain, Patients -- Safety measures, Medical care -- Decision making | ||||||||
| Journal or Publication Title: | Social Science & Medicine | ||||||||
| Publisher: | Elsevier | ||||||||
| ISSN: | 0277-9536 | ||||||||
| Official Date: | May 2021 | ||||||||
| Dates: |
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| Volume: | 277 | ||||||||
| Article Number: | 113906 | ||||||||
| DOI: | 10.1016/j.socscimed.2021.113906 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Date of first compliant deposit: | 21 April 2021 | ||||||||
| Date of first compliant Open Access: | 5 April 2022 | ||||||||
| Is Part Of: | 1 |
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