Reportable events with undesired effects in interactions with healthcare services: a qualitative study from the perspective of patients and caregivers

Introduction: Including the voice of patients and caregivers is essential when it comes to analyzing reportable events with undesired effects (REUEs), in order to develop safety policies and strategies adapted to the realities of those who must be at the center of the healthcare system. Objective: To understand, from the perspective of patients and caregivers, the experiences and meanings associated with REUEs attributable to the interaction with healthcare services. Methods: Qualitative interpretive study, phenomenological approach. Interviews were used to explore how patients or caregivers perceive and experience REUEs, identifying social determinants that influence safety. The study explored how the determinants affect access in the care environment and how they contribute to the chain of events that culminate in an adverse event. Results: Overall, 31 interviews were conducted. All the events analyzed were serious REUEs. The deficiencies reported by patients and caregivers included breakdowns in access, timeliness, quality and continuity of care and combinations thereof. Contributing factors included the lack or shortage of financial means, distance to care sites, social situations such as a poor support network or absence of caregivers, and problems of public unrest and insecurity in some regions. Conclusions: Limited access and delays in care are reported factors and result in REUEs, greater burden of disease and complications, disproportionately affecting the most vulnerable populations. The perspective of the participants underscores the urgency of addressing these problems if safety in healthcare is to be improved, and points to the importance of incorporating those perspectives into the design of policies and interventions that address structural inequities in health systems.