| Characteristics of patients |
Problematic presentation; Cognitive and educational deficiencies |
Risks vs. Benefits of taking medications; Mismatch between patient behaviour and system requirements |
| Relationships between primary health care staff |
Deference towards GPs; Clinical autonomy creates communication problems; A need for “free” and open two-way communication without fear of blame |
Pharmacists’ access to GPs and medical records; Poorly performing GPs; The degree of face-to-face contact between different health workers |
| Communication between patients and staff |
“To create a feeling of safety” [63]; Communication between doctors and patients mediated by receptionists and telephones (potential for further errors) |
Pressures of time; Prescribing reduces face-to-face contact between patients and staff |
| Knowledge |
Insufficient time for medication counselling with patients; Inflexibility and irrelevance of guidelines; New drugs |
Lack of transparency and access to information in EHRs; Drug and therapeutics training “picked up on the job” [59] |
| Responsibility |
Whosoever has the responsibility gets the blame; Responsibility and control resides with the patients’ own doctor or prescriber, but it needs to be shared out with other doctors and patients; A tension between getting patients involved and eroding professional trust (and power?) |
Power versus competence; Systems versus ad hoc approaches |
| Workflow |
Getting around unhelpful guidelines and systems within pressures of workload |
Time and resource constraints mean adhering to guidelines or systems can introduce ‘new’ errors; Working around and dealing with unhelpful computer systems |
