From: Patient safety in marginalised groups: a narrative scoping review
Study | Country of study | Economic level | Study Aim | Marginalised Group/Study population(s) | Number of participants/studies (if reviews) | Study setting | Study primary patient safety outcome(s) |
---|---|---|---|---|---|---|---|
Abizanda (2014) [34] | Spain | High | “To analyse the longitudinal association between frailty, disability, multimorbidity or incident disability in a cohort of older adults” | Frail | 842 | Secondary | Mortality |
van Rosse (2016a) [8] | The Netherlands | High | “The following research questions were answered in this study: “1. At which moments during hospitalization do language barriers constitute a risk for patient safety? 2. How are language barriers detected and reported in hospital care? 3. How are language barriers bridged in hospital care? What is the policy and what happens in practice” | Ethnic minority patients | 576 | Secondary | Communication/ Language barriers |
Heyland, 2016 [35] | Canada | High | “The purpose of this paper is to determine the prevalence and nature of errors related to EOL communication and documentation of preferences.” | Frail | 808 | Secondary | Medical error |
van Rosse (2016b) [36] | Netherlands | High | “To analyse the role of these relatives in relation to the safety of patients during hospital care.” | Ethnic minority patients and their relatives (non-western) | 576 | Secondary | Communication |
Storeng (2012) [37] | Burkina Faso | Low | 2To challenge “the maternal health literature’s suggestion that women’s health outcomes will be satisfactory if they can access skilled attendance at delivery and emergency obstetric care when pregnancy and delivery complications occur. In this paper, we challenge this assumption through an analysis of the long-term outcomes of ‘Near miss’ obstetric complications.” To “illustrate broader trends that help to explain Burkinabe women’s vulnerability to maternal morbidity and to mortality more generally.” | Women after childbirth in low socioeconomic circumstances | 1014 | Secondary | Near miss |
Beck (2017) [38] | USA | High | “To determine, qualitatively, how the hospitalisation and hospital-to-home transition experiences differed between families of varying SES. Sessions were stratified based on SES, determined by the percentage of individuals living below the federal poverty level in the census tract or neighbourhood in which the family lived.” | Families of low and high socioeconomic status | 61 | Secondary | Access to care |
Ferguson 2015 [39] | USA | High | “The purpose of this research is to identify communication barriers and needs for Deaf and Hard of hearing (HOH) patients when they seek pharmaceutical care, and to better understand the impact of poor communication upon medication adherence and medication errors among this underserved population.” | Deaf/Hard of Hearing (HOH) | 20 | Community | Communication issues |
Cantarero 2014 [40] | Denmark | High | “The aim was twofold: [1] to explore the perceptions, barriers and needs of Arabic-speaking ethnic minorities regarding medicine use, and [2] to use an educationprogram to enhance the knowledge and competencies of the ethnic minorities about the appropriate use of medicines.” | Arabic speaking Ethnic minorities | 30 | Multiple | Appropriate medicine use |
Berry 2017 [41] | USA | High | “This study investigates how family members administered prescription and over-the counter medications to elders with Alzheimer’s”. | Carers | 15 | N/S | Medication misuse |
Groene 2012 [42] | Spain | High | “The objective of our study was to explore the role and engagement of patients in the handover process with a particular focus on these vulnerable patients.” | Vulnerable patients (patients with limited language comprehension or health literacy, or a lack of social resources or support) | 12 patients (5 M, 7F) 6 hospital physicians, 5 hospital nurses, 7 primary care physicians, 4 primary care nurses. | Multiple | Discharge |
Hole 2015 [43] | Canada | High | Not stated but; “What are community members’ opinions, perspectives, and analysis of the health care system that they interact with, beginning in this instance, at the hospital door?” | Aboriginal people (Syilx people) | 28 Aboriginal community members | N/S | Culturally unsafe health care provision |
Stenhouse 2013 [44] | UK | High | “To understand the experience of being a patient on an acute psychiatric inpatient ward.” | Psychiatric inpatients | 13 | Secondary | Inpatient safety |
Roost 2009 [87] | Bolivia | Lower-middle | “By means of thematic interviews with women who have experienced severe obstetric complications (Near miss), this study explores the way health care-seeking behaviour is conditioned in an urban Bolivian setting that offers free and easily accessible maternal health care.” | Women from urban (higher SES) and rural (lower SES) who had experienced a Near miss event | 30 | Secondary care | Near miss |
Mohammadi 2017a [45] | Iran | Upper middle | “To explore the experiences of maternal care among Afghan Near miss survivors in Tehran to increase insights into strategies for reducing delays and providing optimal and equitable care for migrants” | Non-indigenous/migrant women and native women | 82 women (60 Iranian plus 22 Afghan women) | Secondary | Near miss |
Zhi-Han 2017 [46] | Malaysia (Kuala Lumpur) | Upper-middle | “To identify the problems encountered by the visually impaired population when handling their medication.” | Visually impaired | 100 (62 blind, 38 visually impaired) | Primary care | Medication safety |
Latham 2011 [47] | UK | high | “The purpose of this study was to examine to what extent pharmacy labels follow the existing best practice guidelines of the Design for Patient Safety (DfPS) and The purpose of this experiment was to determine whether labels produced to DfPS guidelines have the potential to be more accessible to patients with impaired vision” | Visually normal patients with simulation to produce visual impairment | 20 | NS | Medication information |
Lahousse 2014 [48] | The Netherlands | High | “The aim was to investigate the prevalence of physically frail elderly in a Dutch population-based cohort study and the impact on adverse health outcomes including all-cause mortality independent of comorbidity.” | Frail | 2833 | Population | Adverse outcomes |
Ekerstad 2017 [49] | Sweden | High | “Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early re-hospitalizations.” | Frail | 408 | Secondary | Adverse Drug Reactions |
Hastings 2008 [50] | USA | High | “To determine whether frail older adults, based on a deficit accumulation index, are at increased risk of adverse outcomes following discharge from the Emergency Department. Specifically, to examine the association between frailty and [1] any adverse outcome, [2] outpatient ED visits, and [3] more serious events defined as hospitalization, nursing home admission or death.” | Frail | 1851 | Secondary | Adverse outcomes |
Friedman 2008 [51] | USA | High | Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during hospitalization, so that interventions can be developed to reduce risk.” | Care Home Residents | 212 | Care home | Adverse outcomes |
Zaal 2013 [52] | Netherlands | High | “ [1] To determine the prevalence of older individuals with an intellectual disability with at least one prescription error and [2] to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation).” | Patients (>/=50y) with Intellectual Disability (IQ </=70), using one or more drugs | 600 | Primary | Prescribing errors |
Shen 2016 [53] | USA | High | “To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients” | Patients of various ethnicities and health insurance status | 3,052,268 | Secondary | Patient safety indicators (PSIs) |
Lin 2011 [54] | Taiwan | High | “To clarify whether intellectual disability (ID) is an independent risk factor for in-hospital major surgeries, and to validate the postoperative adverse outcomes in patients with ID” | Surgical patients with intellectual disability | 3983 cases plus ×4 matched controls | Secondary | Adverse outcomes |
Marcus 2018 [55] | USA | High | “To examine adverse events and medical errors occurring in VHA hospital psychiatric units” | Psychiatric patients | 8005 discharges | Secondary | Patient Safety Indicators (PSIs) |
Gaskin 2011 [56] | USA | High | “Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals.” | Ethnic minorities | 1620 | Care home | Patient Safety Indicators (PSIs) |
Maly 2011 [57] | USA | High | The purpose of this study was to identify correlates of elapsed time between recognition of breast abnormalities and receipt of definitive diagnosis of breast cancer among low-income women. | Low income women | 921 | Population | Diagnostic delay |
Drumond 2013 [58] | Brazil | Upper middle | “This study aims to evaluate the quality of information about race/colour (black or white) in health information systems and to analyse the causes of infant mortality in the Brazilian List of Avoidable Causes of Death by race/colour in Belo Horizonte in 2001–09.” | Ethnic minority patients | 3863 | Secondary | Avoidable deaths |
Fernandes 2017 [59] | Brazil | Upper middle | “Purpose To evaluate the association between ethnic differences and the occurrence of maternal near miss (MNM) in the Amazon and Northeast regions of Brazil.” | Ethnic Minority mothers and their infants | 16,783 | Secondary | Near miss |
Katzenellenbogen 2013 [60] | Australia | High | “This study aimed to investigate demographic and clinical factors that predict Discharge Against Medical Advice (DAMA) in patients experiencing their first-ever inpatient admission for ischaemic heart disease (IHD). The study focuses particularly on the differences in the risk of DAMA in Aboriginal and non-Aboriginal patients while also investigating other factors in their own right.” | Aboriginal and Non-aboriginal | 37,304 people | Secondary | Discharge Against Medical Advice (DAMA) |
Haw 2003 [61] | Scotland | High | “To determine the nature, frequency and potential severity of prescribing errors detected by pharmacists working in a psychiatric hospital and to suggest ways that errors might be reduced.” | Psychiatric patients | 311 errors | Tertiary care | Prescribing errors |
da Costa 2016b [75] | Portugal | High | “To determine the prevalence and nature of Drug-Related Problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist’s intervention.” | Care Home Residents | 126 | Care homes | Drug related problems |
Garrett 2008 [63] | Australia | High | “While researching the experience of acute patients with limited English, it became evident that some had experienced negative hospital events. This study examined the perception of these negative events, and factors that might prevent or minimise them” | Ethnic minorities | 278 | Secondary | Communication/ language issues |
Khaykin 2010 [64] | United States | High | “The purpose of this study was to determine the association between diagnosis of schizophrenia and adverse events during non-psychiatric hospitalizations.” | Patients with and without schizophrenia | 37,362,038 admissions (269,387 non-psychiatric hospitalizations with schizophrenia, and 37,092,651 without) | Secondary | Patient safety indicators (PSIs) |
Hubbard 2017 [65] | Australia | High | “We evaluate the predictive validity of the FI-AC in older inpatients. We consider how admission FI-AC score relates to discharge destination and explore its association with other clinically important adverse outcomes.” | Frail | 1418 patients | Secondary care | Adverse outcomes |
Kandil 2012 [66] | Egypt | Lower-middle | “We designed this study in order to find out the patterns of medication errors and their percentage in an obstetric emergency ward so that we can develop specific strategies to prevent or minimize re-occurrence.” | Women in a low resource setting | 10,000 women | Secondary care | Medication error |
Bickley 2006 [67] | UK | High income | “To establish the numbers of homeless patients in contact with services who die by suicide; to describe their suicide methods and their social and clinical characteristics including aspects of clinical care”. | Homeless people | 131 | Multiple | Suicide |
Mohammadi 2017b [68] | Iran | Upper middle | “To investigate whether care quality for maternal Near miss (MNM) differed between Iranians and Afghans and identify preventable attributes of MNM” | Non-indigenous/migrant women and native women | 76 cases reviewed & 24 MNM mothers interviewed | Secondary | Near Miss |
Sarkar 2010 [69] | USA | High | “To examine safety in diabetes patients’ most familiar environment at home, between visits” | Low-income diabetes patients | 111 | Community | Adverse events |
Stadjuhar 2019 [91] | Canada | High | “The purpose of this study was to identify barriers to accessing care among structurally vulnerable people at EOL. | Vulnerable end of life patients | 25 people experiencing structural vulnerability, 25 support persons, and 69 formal service providers | Community (End of life care) | Access |
Gamlin 2018 [94] | Mexico | Upper Middle | “This study aimed to explore the structural determinants of maternal and perinatal health in a Wixárika community located in Northwestern Mexico.” | Pregnant indigenous women | 62 pregnant women | Community | Mortality |
Komiya 2018 [92] | Japan | High | “we investigated the demographic and clinical factors associated with polypharmacy in elderly care home patients, which we expected to be different from those of outpatients, because elderly care home patients are more likely to be frail than outpatients and are not prescribed medications by multiple clinical departments” | Care Home Residents | 153 care home residents | Care Homes | Polypharmacy |
Katikireddi 2018 [93] | UK | High | Not specified | Ethnicity | 4·61 million Scottish people | Population | Adverse Outcomes and Mortality |
Funk 2018 [95] | USA | High | “This study was conducted to assess the hospital experience of older adults with hearing impairment, and to use the findings in formulating suggestions for improving nursing care.” | Deaf/Hard of Hearing (HOH) | 8 older (> 65 yr) adults with self-reported hearing impairment | Secondary | Communication issues |
Bennett 2014 [70] | Australia | High i | “In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug–drug interactions (DDIs)”. | Frail | 204 | Tertiary care | Adverse outcomes |
deBruijne 2013 [71] | Netheralnds | High | “We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands.” | Ethnic minority patients | 433,501 patients in 139 hospital locations | Secondary | Adverse outcomes |
Poudel 2016 [72] | Australia | High income | “We aimed to determine the prevalence of polypharmacy and its association with adverse outcomes in hospitalized older patients and to assess the additional role of frailty” | Frail | 1418 | Secondary | Adverse Outcomes |
Reime 2012 [73] | Germany | High | “To examine the association between region of origin and severe illness bringing a mother close to death (Near miss).” “We examined the association between maternal regional origin and four indicators of maternal Near miss, namely hysterectomy, haemorrhage, sepsis and eclampsia, first to describe the association between maternal regional origin and near miss complications and second to test whether higher risks among women with migrant background can be explained by the women’s socioeconomic characteristics, health-related behaviour and pre-existing maternal conditions” | Migrant mothers | 441,199 | Secondary | Near miss |
Bronskill 2012 [74] | Canada | High income | “The use of multiple, concurrent drug therapies often referred to as polypharmacy, is a concern in long term care (LTC) setting, where frail older adults are particularly at risk of dose adverse events. We quantified the scope of this practice by exploring variation in the use of nine or more drug therapies across LTC homes. | Care home residents | 64,394 residents in 589 care homes. | Care homes | Polypharmacy |
da Costa 2016a [62] | Portugal | High | “Objective This study aimed to determine the prevalence of Potentially Inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents.” | Care home residents | 161 | Care home | Potentially Inappropriate Medications |
Desai 2013 [76] | UK | High | “The objectives of this study were [1] to characterize nursing home anticoagulant medication errors, [2] to study their causes and outcomes, and [3] to evaluate their association with patient harm.” | Care home residents | 32,176 individual medication error incidents | Care homes | Medication errors |
DeVylder 2015 [77] | USA | High | “To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behaviour.” | Psychiatric patients | 11,716 | Population | Twelve-month suicidal ideation and suicide attempts |
Hoffman 2003 [78] | USA | High income | This project was undertaken to reduce the inappropriate use of bed rails in a long-term care facility without increasing the risk of injuries caused by falls | Care home residents | 180 beds | Care home | Adverse outcomes |
Cromwell 2005 [79] | USA | High | The objective of this study was to explain race/ethnic disparities in hospitalizations, utilization of high-technology diagnostic and revascularization services, and mortality of elderly ischemic heart disease (IHD) patients. | Ethnic minority patients | 700,000 | Secondary | Access to care |
Dent 2014 [80] | Australia | High | “The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes.” | Frail | 172 | Secondary | Adverse outcome |
van Rosse 2014 [81] | Netherlands | High | “1) Assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; 2) analyse what patient-related determinants affect the risk of AEs; 3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; 4) explore possible strategies to prevent inequalities in patient safety” | Dutch and Ethnic minority patients | 1339 (763 Dutch patients and 576 ethnic minority patients) | Secondary | Adverse events |
Briesacher 2005 [82] | USA | High income | “To test whether nationally required drug use reviews reduce exposure to inappropriate medications in nursing homes”. | Care home residents | Nationally representative population sample of 8 million nursing home (NH) residents (unweighted n52,242) and a comparative group of 2 million assisted living facility (ALF) residents (unweighted n5664). | Care homes | Adverse drug reactions |
Boockavar 2004 [83] | USA | High income | “To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes”. | Care home residents | 87 residents | Multiple | Adverse drug Events |
Adisasmita 2015 [84] | Indonesia | Lower-middle | “To evaluate the associations between maternal demographic and health care related characteristics and obstetric diagnoses with mode of delivery and Near miss and death and To predict outcomes based on socio-economic status, personal barriers, access barriers to care and referral patterns” | Low and high income pregnant women | 1358 retrospective (no socio-economic data) + 1240 prospective (Interview data only on 56.8%). | Secondary | Near miss |
Castle and Engberg 2007 [85] | USA | High income | “We examine deficiency citations for medication use, with an emphasis on psychoactive drug use”. | Care home residents | 16,533 facilities | Care homes | Inappropriate use of medication |
Pepper 2007 [27] | NS | Unclear as countries not stated | “The purpose of this research synthesis was to examine the published literature to develop estimates of the incidence, severity and costs of medication errors in nursing homes and other institutional long-term care settings.” | Care home residents | 65 | Care homes | Medication errors |
Almeida 2013 [28] | Studies from Europe, USA, Canada, Australia | high (all included) | “To review the existing scientific evidence on the access, use and quality of healthcare in migrant populations during pregnancy and postpartum period, with particular emphasis on how this interferes with health indicators and outcomes” | Migrant women | 30 studies | Population | Access |
Khanassov 2016 [29] | USA, Canada, UK, New Zealand, Australia, Italy | High | “The purpose of this scoping review was to describe the nature and breadth of published research studies in peer reviewed academic journals on organisational interventions improving access to primary care services for vulnerable populations, and reducing consequences of poor access in these populations.” | Vulnerable populations | 39 studies | Primary care | Access |
Alhomoud 2013 [30] | UK | High | “To review and establish types and possible causes of medicine related problems experienced by ethnic minorities in the UK” | Ethnic minority patients | 15 studies | Multiple | Medicine related problems |
Castro 2015 [31] | Latin America | Upper middle | “To identify and understand the barriers to equitable care within health care settings that women of ethnic minorities encounter in Latin America and to examine possible strategies for mitigating the issues.” | Women of ethnic minorities | 60 studies | Multiple | Communication |
Corsonello 2009 [32] | Italy | High | “Therefore, we will review the evidence pertaining to the application of Beers’ criteria in elderly hospitalized patients, while focusing on Italian studies that have investigated the role of PIMs as potential predictors of negative hospital outcomes. In addition, we will also review the available evidence regarding new European criteria on identifying PIMs, because clinical application in elderly hospitalized Europeans is still under investigation.” | Frail | 5 studies | Secondary | Potentially inappropriate medication |
Hemsley 2014 [33] | N/S | N/S | “The aims of the present review were to map the evidence on communication in hospital for patients with severe communication disabilities; to synthesize the findings of original relevant research in order to propose an evidence-based set of core strategies suggested to improve communication, and to propose a translational research agenda to improve communication in hospital. This includes raising the awareness in all stakeholders for the need for proper evaluation of any suggested strategies to improve hospital communication for this population” | Patients with severe communication disabilities | 18 studies | Multiple | Communication/ language issues |
Hoffmann 2019 | Germany | High | “our aim was to give an overview on the existing literature on a) the occurrence of hospitalizations at the end of life in NHR with dementia and b) to compare these figures to NHR without dementia in the subset of studies reporting both groups.” | End of life nursing home residents with dementia | 13 studies | Multiple | Adverse Outcomes (hospitalisation) |