title: Patients' perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research.
abstract: OBJECTIVE
  To synthesise the published literature on the patient experience of the medical primary-secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes.
  
  
  METHODS
  Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients' perspectives of the medical primary-secondary care interface.
  
  
  METHODS
  International primary-secondary care interface.
  
  
  METHODS
  EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature.
  
  
  METHODS
  Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients' perspectives of the medical primary-secondary care interface.
  
  
  METHODS
  The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data.
  
  
  RESULTS
  The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary-secondary care interface from the patients' perspective emerged: barriers to care, communication, coordination, and 'relationships and personal value'.
  
  
  CONCLUSIONS
  Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface.
  
  
  BACKGROUND
  PROSPERO CRD42014009486.
authors.affiliation: Cairn Medical Practice, Inverness, UK.
authors.forename: Rod
authors.initials: R
authors.lastname: Sampson
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Cooper
authors.affiliation: The Open University, Milton Keynes, UK.
authors.forename: Rosaline
authors.initials: R
authors.lastname: Barbour
authors.affiliation: Highland Health Sciences Library, Centre for Health Science, Inverness, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Polson
authors.affiliation: Centre for Rural Health, University of Aberdeen, The Centre for Health Science, Inverness, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
mesh_terms: D003142:Communication; D006801:Humans; D057240:Patient Preference; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D063127:Secondary Health Care / Q000592:standards*
keywords: PRIMARY CARE; QUALITATIVE RESEARCH