Patient safety of virtual primary care: A qualitative study examining risks and mitigation strategies

• Risks of virtual care use vary from technological hurdles to fundamental challenges surrounding how consultations are to be performed through a novel communication medium. • Potential solutions to support better virtual consultation use range from strategies to strengthening micro-level patient-provider interactions to larger-scale system changes to improve the continuity of care. • Attention should be paid to ensuring any new virtual care advancements enhance accessibility for underrepresented groups and do not contribute to exacerbating the digital divide. 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. 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. Three focus groups were conducted followed by 26 semi-structured interviews with patients, carers and healthcare providers working in primary care. Data were analysed following a thematic analysis approach. 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 consequences for patients’ access to care, and worsening workload burden and exacerbating staff dissatisfaction. 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. 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. 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 effective coordination and integration between virtual and in-person healthcare so as to maximise the benefits of both modalities of healthcare delivery.