Primary Care Providers’ Perspectives on Errors of Omission

Article Figures & Data

Table 1.

Summary of Key Questions in the Interview Guide

Describe the care you usually deliver when you have adequate time.
If there are times you don’t deliver that care, what types of care are omitted?
What clinical care is regularly missed? Why is that clinical care omitted? Probes: inadequate staffing? Cannot collaborate with colleagues? Poor communication among staff?
How does omitted care affect patients?
How can care omissions be prevented?

Table 2.

Characteristics of the Study Participants (N = 26)

Demographics	Participants
Occupation, N (%)
Physician	12 (46)
Nurse practitioner	14 (54)
Age (years), mean (SD)	43.46 (11.16)
Experience (years), mean (SD)	9.63 (7.5)
Sex (women), N (%)	20 (77)
Highest degree, N (%)
Master’s	5 (19)
Post-master’s	3 (12)
MD	11 (42)
Doctorate (PhD; DNP; PhD/MD)	7 (27)
Practice characteristics
Main practice site, N (%)
Private practice	5 (19)
University-affiliated clinic	11 (42)
Hospital-affiliated clinic	9 (35)
Federally qualified health center	1 (4)
Geographic location, N (%)
Urban	17 (65)
Suburban	8 (31)
Rural	1 (4)

Table 3.

Summary of the Emergent Themes from the Interviews of Primary Care Providers

Theme	Categories and Examples of Corresponding Codes
Typology of errors of omission	Patient teaching
	Health maintenance
	Medication education
	Review of tests and diagnostics with patient
	Diet education
	Healthy lifestyle education
	Physical activity recommendations
	Weight management
	Preprocedural education
	Patient Followup
	Followup about test results
	Followup about referrals
	Followup on provider recommendations
	Emotional support
	Family and caregiver support
	Review of patient coping mechanisms
	Social wellbeing
	Mental health needs
	Depression screening
	“Mental health not part of primary care”
Factors leading to omissions	Time Constraints
	Overbooking of appointments
	Time spent on documentation
	Increased complexity of patient visits
	Time spent on phone with insurance companies to gain approvals for diagnostic testing
	Unplanned patient visits and emergencies
	Urgent change in patient medical status
	Unstable patient
	Patient volume
	Unexpected patient emergencies
	Open scheduling
	Administrative burden
	Lack of support staff
	Influx of telephone messages to answer
Omission safeguards	Organizational support and infrastructure
	Designated time allotted for administrative work (eg, answering patient phone calls; paperwork)
	Enough patient care resources (eg, exam rooms; support staff)
	Adequate staffing
	Effective teamwork and communication
	Effective team communication
	Respect for team members
	Preparation for the patient encounter
	Easy access to patient history and plan of care
	Review of patient care documentation