"We could do more": exploring violance prevention measures in German outpatient primary care - a qualitative study.

BACKGROUND: Healthcare workers in general practice are exposed to verbal and physical violence from patients and accompanying persons. While research has predominantly focused on hospital settings, evidence on violence prevention in primary care remains limited. General practice staff often report feeling insufficiently prepared to manage aggressive behaviour. This study explored staff perceptions of violence prevention measures in outpatient care, including perceived usefulness, implementation barriers, and unmet needs. METHODS: A qualitative study was conducted involving 45 semi-structured interviews with physicians and medical assistants working in direct patient care in German general practices. Interviews explored experiences with violence prevention measures, perceived usefulness, barriers to implementation, and additional needs. Data were analysed using qualitative content analysis according to Mayring. RESULTS: Participants described environmental (e.g., alarm systems), organisational (e.g., staff organisation and practice procedures), and individual-level measures (e.g., communication strategies and staff training) for violence prevention in ambulatory care. Violence prevention was perceived as a multi-layered organisational process rather than a single intervention. In many practices, formal violence prevention guidelines or standard operating procedures were absent, insufficiently implemented, or perceived as impractical for routine care. Exploratory comparisons suggested that these overarching themes were largely consistent across practice settings, professions, and gender, with contextual differences primarily reflecting professional roles and organisational circumstances. CONCLUSIONS: Violence prevention in general practice requires a systematic, multi-level approach addressing environmental, organisational, and individual factors. Adequate staffing and manageable workloads appear central to enabling consistent implementation of preventive strategies across different primary care contexts. Practice-specific guidance should be developed, communicated, and integrated into routine care to support structured responses to aggression. Future research should further explore and evaluate tools for early identification of patients at risk of aggression and examine how contextual factors influence the implementation and effectiveness of violence prevention strategies in primary care.