Patients' perceptions of error in long-term illness care: qualitative study.

OBJECTIVES: To explore patients' perceptions of events that may represent errors in long-term illness care and evaluate potential associations with dimensions of quality in health care.
METHODS: Qualitative study based on semi-structured interviews with 33 patients with long-term conditions.
RESULTS: Patients' accounts revealed experiences of errors arising from health care. Errors of access included difficulties of gate-keeping leading to problems in gaining access to primary care consultations, diagnostic tests and specialist care. Potential harms included delayed diagnosis or delayed delivery of specialist care. Errors of interpersonal care included patients' perceptions of not being taken seriously, including perceived failure by professionals to respond adequately to reports of adverse drug reactions or accounts of painful symptoms. Potential harms included continuing medication-related symptoms, negative emotional reactions and breakdown in communication between patients and professionals. Errors were noted at transitions between primary and secondary care including failures of information transfer and communication.
CONCLUSIONS: Problems of gaining access to care and problems at transitions between levels of care may sometimes constitute errors, but they may also give rise to circumstances in which errors occur. Interpersonal and communication problems may also be associated with errors. There appears to be a close relationship between broader concepts of quality of care and the concept of patient safety.