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Table 3 Description of included studies

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)