title: Patients' and carers' perceptions of safety in rural general practice.
abstract: OBJECTIVE
  To explore patients' and carers' experiences of rural general practice to identify their perceptions of safety of care.
  
  
  METHODS
  Four focus group interviews were conducted with 26 rural patients and carers in south-west Victoria between September and December 2012. Frequent users of general practice were recruited from local allied health self-management programs and a mothers' group. Focus groups were audio recorded, transcripts were independently analysed and interpreted using narrative methodologies.
  
  
  RESULTS
  Participants who had experienced some level of harm were able to comment more extensively on safety aspects of care. Several key themes related to safety were identified from the analysis of all participant narratives. An assumed sense of safety in general practice was predominant, and was influenced by participants' level of risk awareness and trust in their general practitioner. Additional unique themes included feelings of vulnerability, desire for an explanation and apology, a forgiving view of mistakes, and preference for GP interpersonal skills over competence.
  
  
  CONCLUSIONS
  This study revealed new insights into the factors that influence patients' and carers' perspectives of safety, and demonstrated the value of incorporating the patient voice into safety research. An assumed sense of safety due to a default position of trust, coupled with limited risk perception, directly contests the current literature on patient involvement in safety. Further exploration is required to determine how patients and carers can effectively engage in and assist with improving safety in general practice.
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia. andrea.hernan@greaterhealth.org.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hernan
authors.affiliation: Executive Office, Chronic Illness Alliance, Melbourne, VIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Walker
authors.affiliation: School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Johnson
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia.
authors.forename: Amr
authors.initials: A
authors.lastname: Abou Elnour
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Dunbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D058006:General Practice; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D061214:Patient Safety; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012308:Risk Management / Q000458:organization & administration; D019035:Rural Health Services; D017751:Safety Management; D035502:Trust; D014739:Victoria; D035862:Vulnerable Populations