NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.
Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.
Int J Equity Health. 2020 Feb 12;19(1):26. doi: 10.1186/s12939-019-1103-2.
Marginalised groups ('populations outside of mainstream society') experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising.
Scoping review. Systematic searches were performed across six electronic databases in September 2019. The time frame for searches of the respective databases was from the year 2000 until present day.
The searches yielded 3346 articles, and 67 articles were included. Patient safety issues were identified for fourteen different marginalised patient groups across all studies, with 69% (n = 46) of the studies focused on four patient groups: ethnic minority groups, frail elderly populations, care home residents and low socio-economic status. Twelve separate patient safety issues were classified. Just over half of the studies focused on three issues represented in the patient safety literature, and in order of frequency were: medication safety, adverse outcomes and near misses. In total, 157 individual contributing or associated factors were identified and mapped to one of seven different factor types from the Framework of Contributory Factors Influencing Clinical Practice within the London Protocol. Patient safety issues were mostly multifactorial in origin including patient factors, health provider factors and health care system factors.
This review highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments. Such understanding provides a basis for working collaboratively to co-design training, services and/or interventions designed to remove or at the very least minimise these increased risks.
Not applicable for a scoping review.
边缘化群体（“主流社会之外的人群”）经历着严重的健康不平等，并且更有可能遭遇患者安全事件。然而，迄今为止，尚无审查能够确定、绘制和分析这一领域的文献，以了解 1）在患者安全研究方面研究了哪些边缘化群体，2）这些群体存在哪些特定的患者安全问题，以及 3）导致或与这些安全问题相关的因素。
范围综述。2019 年 9 月，在六个电子数据库中进行了系统检索。各数据库的检索时间范围为 2000 年至今。
检索结果共 3346 篇文章，纳入 67 篇文章。在所有研究中，14 个不同的边缘化患者群体都存在患者安全问题，其中 69%（n=46）的研究集中在四个患者群体：少数民族群体、体弱老年人、养老院居民和低社会经济地位。共分类了 12 个单独的患者安全问题。超过一半的研究集中在患者安全文献中代表的三个问题上，按频率依次为：用药安全、不良后果和接近差错。总共确定并映射了 157 个单独的促成或相关因素到伦敦协议框架中的临床实践影响因素框架中的七种不同因素类型之一。患者安全问题主要是多因素引起的，包括患者因素、医疗服务提供者因素和医疗保健系统因素。
本综述强调边缘化患者群体容易经历各种患者安全问题，并指出了一些差距。研究结果表明，需要进一步研究以了解边缘化的交叉性质和患者安全问题的多维性质，包括那些研究不足的群体，包括有心理健康问题、沟通和认知障碍的群体。这种理解为共同设计旨在消除或至少最小化这些增加的风险的培训、服务和/或干预措施提供了基础。
不适用范围综述。
