The safety of health care for ethnic minority patients: a systematic review

Abstract

Introduction: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. Objectives: To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. Method: A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Results: Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Conclusion: Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter-and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. Review registration: This systematic review is registered with Research Registry: reviewregistry761.

Spatial Patterns in Hospital-Acquired Infections in Portugal (2014–2017)

“…Furthermore, the quality of the population’s access to primary healthcare and the optimization of the service performance could be determining factors [ 73 , 74 , 75 ] as it could prevent people being admitted to a hospital with greater vulnerability and a higher risk of susceptibility to infection. Another important factor is related to socio-economic and racial factors; there are already a few studies in which these factors have been found to be significant in association with patients who acquire an infection after an extended stay in hospital [ 76 , 77 ]. In a prospective investigation, it may be useful to cross-reference data on the consumption of antibiotics, disaggregated at the municipal scale, with the highest spatial incidence of HAIs, also controlling for the origin of the patients, specifically whether they come from their own dwelling or if they are residents in nursing homes, where the level of previous infections and antibiotic use is unknown.…”

How do health services engage culturally and linguistically diverse consumers? An analysis of consumer engagement frameworks in Australia

“…There is emerging evidence identifying factors that present barriers to CALD consumer engagement, leading to variations in access to and experience of healthcare, and poorer health and healthcare quality outcomes 14,20–22 . A recent systematic review concluded that safety events (events that could have or did result in harm due to care they receive) among CALD patients are dependent on the setting and the population, and that poor engagement with CALD consumers is one factor associated with their increased vulnerability to safety events 23 . Poor engagement is often associated with an inability of the health system to recognise and address the nuanced sociocultural differences that exist between and within diverse CALD groups and with a lack of responsiveness to those differences 14,23 .…”

Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies

“…Their feedback was discussed between the authors and used to revise the tool iteratively through a series of minor amendments to wording and ordering or the tool items. The resulting QuADS tool was also subject to inter-rater reliability analysis between a psychologist, public health and health services researcher through application to 40 studies a recent systematic review with a kappa of 0.65 published by a colleague within our department who was external to this study [ 15 ].…”