title: Beliefs and experiences can influence patient participation in handover between primary and secondary care--a qualitative study of patient perspectives.
abstract: BACKGROUND
  Communication between healthcare settings at patient transfers between primary and secondary care, 'handover', is a critical and risky process for patients. Patients' views on their roles in these processes are often lacking despite the knowledge that patient participation contributes to enhanced safety and wellbeing.
  
  
  OBJECTIVE
  This study aims to improve the knowledge and understanding of patients' perspectives about their participation in handover.
  
  
  METHODS
  Twenty-three Swedish patients with chronic diseases were individually interviewed about their experiences with handovers between three clinical microsystems: emergency room, emergency ward and primary healthcare centres. Data were analysed using inductive qualitative content analysis.
  
  
  RESULTS
  Patients participated within the microsystems by exchanging information, and between microsystems by making contact with and conveying information to their next healthcare provider. Enablers for participation included positive encounters with providers, patient empowerment and beliefs about organisational factors. Patients' trust in their providers, and providers' attitudes were important factors in patients' willingness to communicate. Patients who thought medical records access was shared across microsystems volunteered less information to their providers. Patients with experiences of non-effective handovers took more responsibility in the handover to ensure continuity of care.
  
  
  CONCLUSIONS
  Patients participate actively in handovers when they feel a need for involvement to ensure continuity of care, and are less active when they perceive that their contribution is unnecessary or not valued. In acute care settings with short hospital stays and less time to establish a trusting relationship between patients and their providers, discharge encounters may be important enablers for patient engagement in handovers. The advantages of a redundant handover process need to be considered.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Social Work, Karolinska Institutet, Stockholm, Sweden. maria.flink@ki.se
authors.forename: Maria
authors.initials: M
authors.lastname: Flink
authors.forename: Gunnar
authors.initials: G
authors.lastname: Öhlén
authors.forename: Helen
authors.initials: H
authors.lastname: Hansagi
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
authors.forename: Mariann
authors.initials: M
authors.lastname: Olsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062209:Patient Handoff; D010358:Patient Participation / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D063127:Secondary Health Care / Q000592:standards*; D013548:Sweden; D013597:Systems Analysis