Patient Safety of Remote Primary Care: A Qualitative Study Assessing Risks and Mitigation and Prevention Strategies

Background While virtual care delivery has numerous advantages, it can also introduce safety risks and unintended consequences. Considering that it has become an integral part of today’s healthcare service, uncovering its unintended consequences is imperative to ensure patient safety. Objectives This study aimed to identify patient safety risks associated with virtual primary care, as well as strategies to mitigate these risks based on the perspectives of patients and healthcare providers. Methods Three focus groups were conducted followed by semi-structured interviews with patients, carers and healthcare providers working in primary care. Transcripts were systematically reviewed, and thematic analysis was performed by two independent researchers. Results A total of 42 participants took part in the study. Three main areas for patient safety risks associated with virtual primary care were identified, including suboptimal clinical decision-making, negative impact on patients’ access to care, and worsening the workforce crisis. Strategies to mitigate these risks included providing information for patients, training triage personnel, making technical support available, standardising guidelines, setting up systems for feedback, improving continuity of care, communication, and safety netting. Conclusions Patients and providers now have a heightened awareness of the strengths and pitfalls of virtual care due to their increased familiarity with the use of virtual care technologies. Existing policies need to be updated and new ones devised to minimise risks associated with virtual care and support patient and provider workflows. Public Interest Summary The COVID-19 pandemic galvanized an emergent necessity to deliver care virtually in order to reduce disease transmission. However, given the urgency of the crisis, virtual care was being delivered with minimal protective measures for safety. This study examines the lived experiences of both patients and providers around virtual care use in England. Potential risks of virtual care delivery, and strategies to mitigate these risks, are identified from both perspectives. The risks identified vary from the technological learning curve to the challenges associated with modified patient-provider communication. The potential solutions identified range from strategies to improve micro-level patient-provider interactions to larger-scale system changes to improve the continuity of care. Support for patients and providers alike should be allocated to alleviate unnecessary burdens associated with virtual care. Ensuring patient safety necessitates seamless coordination and interoperability between virtual and in-person healthcare to maintain harmony between the two modes of healthcare delivery. ### Competing Interest Statement AD is executive chair of Preemptive Health and Medicine at Flagship Pioneering. All other authors do not have any competing interests. ### Funding Statement EL, AD and ALN are funded by the NIHR Patient Safety Research Collaborative, with infrastructure support from Imperial NIHR Biomedical Research Centre. The views expressed in this publication are those of the author(s) and not necessarily those of NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Imperial College Research Ethics Committee (ICREC) of Imperial College London gave ethical approval for this work (Reference 21IC6789). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is available upon reasonable request to the corresponding author.