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Table 5 Contributory and/or associated factors to patient safety issue occurrence across included studies

From: Patient safety in marginalised groups: a narrative scoping review

Study

(first author, year)

Institutional Context Factors [ICF]

Organisational & Management Factors [OMF]

Work Environmental Factors [WEF]

Task and Technology Factors [TTF]

Individual (staff) Factors [ISF]

Team Factors [TF]

Patient factors [P]

Factor examples

Implied direction of factor(s) effect for patient safety

Storeng (2012) [37]

1

      

[ICF] Payments for care

Negative

Maly (2011) [57]

    

1

 

3

[P]: 1) Race 2) patient self-efficacy and3) cultural beliefs affecting care. [ISF]: clinical breast examination had longer delay than by mammogram.

Negative

Abizanda (2014) [34]

 

1

    

3

[P]: 1) Frailty, 2) Institutionalisation and 3) disability

Negative

Beck (2017) [38]

1

      

[ICF] Payments for care

Negative

Cromwell (2005) [79]

      

1

[P] Race

Negative

da Costa (2016a) [62]

       

None measured

Not applicable

da Costa (2016b) [75]

       

None measured

Not applicable

DeVylder (2015) [77]

      

2

[P]:1) Psychosis and 2)suicidality

Negative

deBruijne (2013) [71]

1

     

1

[P]:Ethnicity and Payments for care [ICF]

Negative

Dent (2014) [80]

      

1

[P]:Frailty

Negative

Desai (2013) [76]

      

2

[P]:Age, and mental capacity (cognitive ability)

Negative

Ekerstad (2017) [49]

1

     

2

[ICF:]Under-use evidence-based drug treatment and [P]: 1) heart failure and 2) anaemia were predictors for readmission

Negative

Friedman (2008) [51]

      

6

[P]: 1) Worsening function, 2) delirium, 3) depression, 4) falls, 5) pressure sores, and 6) admission from a nursing home.

Negative

Garrett (2008) [63]

  

2

   

1

[WEF] staff workload/pressures and staff neglect, [P] communication/language

Negative

Gaskin (2011) [56]

      

1

[P] No associations for ethnicity

Neutral

Groene (2012) [42]

1

1

     

[OMF]: No commonly accepted standard operating procedures for the exchange of information between secondary care and primary care. Communication and role of patient within discharge variable and unclear [ICF]

Negative

Hastings (2008) [50]

      

1

[P] Frailty

Negative

Haw 2003 [61]

    

2

  

[ISF] Decision-making errors and Errors in prescription writing

Negative

Heyland, 2016 [35]

      

2

[P] Frailty and social support

Negative

Hole 2015 [43]

1

     

2

[P] perceived discrimination and Interpersonal experiences of marginalization (e.g. not being listened to/believed judged in a negative light)) [P]. [ICF] Structural factors.

Negative

Hubbard 2017 [65]

      

1

[P] Frailty

Negative

Katzenellenbogen (2013) [60]

      

3

[P]: emergency admission, alcohol admission with or without mental health-related admission history and Aboriginality

Negative

Khaykin (2010) [64]

     

1

1

[P] Schizophrenia and [TF] effective communication among healthcare providers and between health care providers and this vulnerable patient population.

Negative

Lahousse (2014) [48]

      

1

Access to care - hospital care unaffordable [ICF], poor women-professional communication [ISF], obstetric professionals busy and lack of time [WEF]; mothers felt clinical team unqualified to diagnose illness [P]; low education levels /illiteracy [P]

Negative

Latham (2011) [47]

       

None measured

Not applicable

Lin (2011) [54]

      

1

[P] Intellectual Disability patients - Complications correlated with ID severity, especially in septicaemia.

Negative

Marcus (2018) [55]

       

None stated - measures of events, preventability and harm but not cause.

Not applicable

Reime (2012) [73]

      

1

[P] ethnicity (Women from the Middle East, Asia and Africa/Latin America vs. women from Germany). These differences were not explained by the sociodemographic, behavioural or health-related factors.

Negative

Sarkar (2010) [69]

1

   

2

 

2

[ICF] Systems issues, patient physician communication problems [P] + [ISF], and clinician [ISF] and patient actions-[P]

Negative

Shen (2016) [53]

      

1

[P] Poverty

Negative

Stenhouse (2013) [44]

 

1

     

[OMF] No perceived polices for safeguarding

Negative

van Rosse (2016a) [8]

    

2

 

1

[ISF]1) daily clinician practices e.g. ‘drop-out’ of protocolised name and/or date-of-birth checks not done during critical care moments due to language barriers and 2) lack of use of professional interpreters despite 3/4 hospitals having an explicit policy to encourage use (policies not enacted). Language barriers [P]

Negative

van Rosse (2016b) [36]

    

2

 

1

[P] language and communication issues due to role of relatives

Unclear

Van Rosse (2014) [81]

      

1

There was no significant difference in the incidence of AEs in Dutch patients and in ethnic minority patients [P].

Neutral

Zaal (2013) [52]

 

1

  

1

 

1

[ISF] physicians may prescribe drugs more carefully to individuals with a more severe ID, resulting in fewer errors. [P] Individuals with a more severe ID are being treated in centralized settings [P]. [OMF] Centralised settings employ specialized physicians for people with intellectual disabilities more often.

Positive

Bennett (2014) [70]

      

1

[P] Frailty

Negative

Berry (2017) [41]

      

3

[P] 1) Cognitive decline (Alzheimer’s), 2) social support (as carers taking over medication management) and 3) elder resistance to medication-taking.

Unclear

Bickley (2006) [67]

  

2

 

1

1

1

lack of supervision [WEF], poor patient compliance with medication [P], knowledge of staff [ISF], staffing levels [WEF] and poor communication [TF].

Negative

Boockavar (2004) [83]

1

      

Transitions/discharge related medication issues (between hospitals and nursing homes) [ICF]

Negative

Briesacher (2005) [82]

1

1

     

[ICF] National policy changes designed to affect the use of potentially inappropriate medications and implementation practices of care homes [OMF] led to variation in prescribing of potentially inappropriate medications.

Negative

Bronskill (2012) [74]

 

1

     

[OMF] variation in polypharmacy rates across care homes

Negative

Cantarero (2014) [40]

      

4

[P] Multiple perceptions of medicines and medicine-related problems: 1) not taking meds from Danish doctors, inherited incorrect information from their parents, 2) perceived differences in treatment from doctors due to foreign status, 3) impossible to understand the instructions and recommendations of their doctor in Danish and 4) specific needs concerning appropriate medicine use and information.

Negative

Castle and Engberg (2007) [85]

 

1

     

[OMF] Size of the nursing home and [ICF] Medicaid reimbursement rates.

Positive

Ferguson (2015) [39]

    

1

 

2

[P] 1) unable to communicate due to deafness/Hard of hearing (HOH) and 2) experiencing an adverse event due to deafness/HOH and [ISF] perceived lack of sensitivity by pharmacists

Negative

Hoffman (2003) [78]

       

None stated

Not applicable

Poudel (2016) [72]

       

[P] Frailty

Negative

Adisasmita (2015) [84]

 

1

  

1

 

2

[P] 1) Poverty and 2) delivery outside the hospital are significant risk factors associated with near miss. Hospital/staff practices [ISF] and [OMF] response time.

Negative

Kandil (2012) [66]

    

4

  

[ISF] Administration errors were either due to: wrong 1) rate 2) dose, 3) route or 4) time of administration of the drug.

Negative

Roost (2009) [87]

      

3

[P] 1) Strategies shaped by family traditions and composed experiences 2) The perception of not belonging (lack of knowledge, fears of hospital); 3) Mistreatment and distrust.

Negative

Drumond 2013 [58]

      

2

[P]: Ethnicity and socioeconomic status.

Negative

Fernandes 2017 [59]

1

      

[ICF] Inadequate healthcare access

Negative

Mohammadi 2017a [45]

1

 

1

 

1

 

4

[ICF] Access to care - hospital care unaffordable, poor women-professional communication [ISF], obstetric professionals busy and lack of time [WEF]; mothers felt clinical team unqualified to diagnose illness [P]; low education levels /illiteracy [P] cited as an issue. Lack of understanding caused women to not question health professionals [P]. discrimination - voice not being heard particularly by midwives and feeling as though treated differently [P].

Negative

Mohammadi (2017b) [68]

      

4

Illiteracy [P] and having only primary education [P], low income status [P] and being Afghan [P]

Negative

Zhi-Han (2017) [46]

      

1

[P] vision problems (inability to read the prescription labels)

Negative

Corsonello (2009) [32]

       

none stated

Not applicable

Khanassov (2016) [29]

       

None stated

Not applicable

Pepper 2007 [27]

      

5

[P]: 1) female sex, 2) caucasian,3) great number of medication prescriptions, 4) age less than 85 and 5) not having cognitive impairment.

Negative

Castro 2015 [31]

1

   

1

  

[ISF] Poor communication derived from healthcare professionals not communicating in indigenous languages and resulting in poor quality access to healthcare [ICF].

Negative

Hemsley 2014 [33]

1

 

1

2

2

  

(a) services, systems, and policies needed that support improved communication [ICF], (b) enough time to communication [WEF], (c) ensure adequate access to communication tools (nurse call systems and communication aids [TTF], (d) access personally held written health information [TTF], (e) collaborate effectively with carers, spouses, and parents,[ISF] and (f) increase the communicative competence of hospital staff [ISF].

Negative

Alhomoud 2013 [30]

    

1

 

3

[P]:1) In ethnic minority groups differing cultural perceptions or beliefs about health, illness, prescribed treatment and medical care impact on the use of medicines. 2) Ethnic minority groups have different experiences, needs, values and expectations of illness, prescribed treatment and medical care 3) Language and communication barriers have been identified as a possible contributory factor to Medicine Related Problems.[ISF]: inability to communicate in what is not the ethnic minorities’ mother tongue may lead to discrimination

Negative

Almeida 2013 [28]

1

   

2

 

2

[ICF]: reduced access to health facilities. [ISF]:1) poor communication between providers and patients and 2) less follow-up. [P] 1) higher health risk profile in immigrants and 2) high likelihood of comorbidities.

Negative

Hoffmann 2019 [36]

      

3

[P]: 1) Age, 2) gender and 3) condition (dementia vs. non-dementia)

Unclear

Stajduhar 2019 [91]

2

1

  

1

 

1

[ICF]: 1) social disadvantages and oppressions and 2) The cracks of a ‘silo-ed’ care system. [P]: The normalization of dying (form of fatalism). [ISF]:The problem of identification [OMF] Professional risk and safety management

Negative

Komiya 2018 [92]

      

7

[P]: 1) lower care need level, 2) higher Barthel Index (BI), 3) higher Mini-Nutritional Self-Assessment Short Form (MNA-SF), 4) lower Charlson Comorbidity Index (CCI), 5) the presence of Potentially Inappropriate Medicines (PIM), 6) the presence of pollakisuria, 7) presence of insomnia

Unclear

Katikireddi 2018 [93]

      

1

[P]: Ethnicity

Mixed effects

Gamlin 2018 [94]

  

1

 

2

 

1

[WEF]: 1) the structure of service provision, in which providers have several contiguous days off, [ISF] 1) poor patient-provider dynamic and discriminatory practices and 2) sometimes non-consensual imposition of biomedical practices. [P] men have important roles to play supporting their partners during labour and birth.

Negative

Funk 2018 [95]

      

3

[P]: 1) Health care communication difficulties due to patient non-disclosure of condition, 2) passivity and vulnerability, and 3) frustration with family

Negative