Skip to main content
Top
Published in: International Journal for Equity in Health 1/2018

Open Access 01-12-2018 | Systematic review

Social disparities in patient safety in primary care: a systematic review

Authors: Carlotta Piccardi, Jens Detollenaere, Pierre Vanden Bussche, Sara Willems

Published in: International Journal for Equity in Health | Issue 1/2018

Login to get access

Abstract

Background

Patient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the attention on social disparities in patient safety has been mainly directed towards the hospital care, often overlooking the primary care setting. Therefore, this paper aims to synthesise social disparities in patient safety in the primary care setting.

Methods

The Databases PubMed and Web of Science were searched for relevant studies published between January 1st 2006 and January 31st 2017. Papers investigating racial, gender and socioeconomic disparities in regards to administrative errors, diagnostic errors, medication errors and transition of care errors in primary care were included. No distinction in terms of participants’ age was made.

Results

Women and black patients are more likely to experience patient safety events in primary care, although it depends on the type of disease, treatment, and healthcare service. The available literature largely describes gender and ethnic disparities in the different patient safety domains whilst income and educational level are studied to a lesser extent.

Conclusions

The results of this systematic review suggest that vulnerable social groups are likely to experience adverse patient safety events in primary care. Enhancing family doctors’ awareness of these inequities is a necessary first step to tackle them and improve patient safety for all patients. Future research should focus on social disparities in patient safety using socioeconomic indicators, such as income and education.
Literature
1.
go back to reference Altman DE, Clancy C, Blendon RJ. Improving patient safety—five years after the IOM report. N Engl J Med. 2004;351:2041–3.CrossRefPubMed Altman DE, Clancy C, Blendon RJ. Improving patient safety—five years after the IOM report. N Engl J Med. 2004;351:2041–3.CrossRefPubMed
2.
go back to reference van Rosse F, de Bruijne MC, Wagner C, Stronks K, Essink-Bot M-L. Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods. BMC Health Serv Res. 2012;12:450.CrossRefPubMedPubMedCentral van Rosse F, de Bruijne MC, Wagner C, Stronks K, Essink-Bot M-L. Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods. BMC Health Serv Res. 2012;12:450.CrossRefPubMedPubMedCentral
3.
go back to reference Sandars J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Fam Pract. 2003;20:231–6.CrossRefPubMed Sandars J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Fam Pract. 2003;20:231–6.CrossRefPubMed
4.
go back to reference Sheikh A, Panesar SS, Larizgoitia I, Bates DW, Donaldson LJ. Safer primary care for all: a global imperative. Lancet Glob Health. 2013;1:e182–3.CrossRefPubMed Sheikh A, Panesar SS, Larizgoitia I, Bates DW, Donaldson LJ. Safer primary care for all: a global imperative. Lancet Glob Health. 2013;1:e182–3.CrossRefPubMed
5.
go back to reference Medication errors: WHO technical series on safer primary care. Geneva: World Health Organization; 2016. Medication errors: WHO technical series on safer primary care. Geneva: World Health Organization; 2016.
6.
go back to reference Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43:I48–57.CrossRefPubMed Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43:I48–57.CrossRefPubMed
7.
go back to reference National Heart L, Institute B. Quality assessment tool for observational cohort and cross-sectional studies. Bethesda: National Institutes of Health, Department of Health and Human Services; 2014. National Heart L, Institute B. Quality assessment tool for observational cohort and cross-sectional studies. Bethesda: National Institutes of Health, Department of Health and Human Services; 2014.
8.
go back to reference Becker WC, Starrels JL, Heo M, Li X, Weiner MG, Turner BJ. Racial differences in primary care opioid risk reduction strategies. Ann Fam Med. 2011;9:219–25.CrossRefPubMedPubMedCentral Becker WC, Starrels JL, Heo M, Li X, Weiner MG, Turner BJ. Racial differences in primary care opioid risk reduction strategies. Ann Fam Med. 2011;9:219–25.CrossRefPubMedPubMedCentral
9.
go back to reference Eva KW, Link CL, Lutfey KE, McKinlay JB. Swapping horses midstream: factors related to physicians’ changing their minds about a diagnosis. Acad Med. 2010;85:1112.CrossRefPubMedPubMedCentral Eva KW, Link CL, Lutfey KE, McKinlay JB. Swapping horses midstream: factors related to physicians’ changing their minds about a diagnosis. Acad Med. 2010;85:1112.CrossRefPubMedPubMedCentral
10.
go back to reference Fleming-Dutra KE, Shapiro DJ, Hicks LA, Gerber JS, Hersh AL: Race, otitis media, and antibiotic selection. Pediatrics 2014:peds. 2014-1781. Fleming-Dutra KE, Shapiro DJ, Hicks LA, Gerber JS, Hersh AL: Race, otitis media, and antibiotic selection. Pediatrics 2014:peds. 2014-1781.
11.
go back to reference Green D, Bedson J, Blagojevic-Burwell M, Jordan K, der Windt D. Factors associated with primary care prescription of opioids for joint pain. Eur J Pain. 2013;17:234–44.CrossRefPubMed Green D, Bedson J, Blagojevic-Burwell M, Jordan K, der Windt D. Factors associated with primary care prescription of opioids for joint pain. Eur J Pain. 2013;17:234–44.CrossRefPubMed
12.
go back to reference Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J. Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study. BMC Health Serv Res. 2008;8:49.CrossRefPubMedPubMedCentral Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J. Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study. BMC Health Serv Res. 2008;8:49.CrossRefPubMedPubMedCentral
13.
go back to reference McKinlay JB, Marceau LD, Piccolo RJ. Do doctors contribute to the social patterning of disease: the case of race/ethnic disparities in diabetes mellitus. Med Care Res Rev. 2012;69:176–93.CrossRefPubMed McKinlay JB, Marceau LD, Piccolo RJ. Do doctors contribute to the social patterning of disease: the case of race/ethnic disparities in diabetes mellitus. Med Care Res Rev. 2012;69:176–93.CrossRefPubMed
14.
go back to reference Schröder W, Sommer H, Gladstone BP, Foschi F, Hellman J, Evengard B, Tacconelli E. Gender differences in antibiotic prescribing in the community: a systematic review and meta-analysis. J Antimicrob Chemother. 2016;71:1800–6.CrossRefPubMed Schröder W, Sommer H, Gladstone BP, Foschi F, Hellman J, Evengard B, Tacconelli E. Gender differences in antibiotic prescribing in the community: a systematic review and meta-analysis. J Antimicrob Chemother. 2016;71:1800–6.CrossRefPubMed
15.
go back to reference Cooper JA, Moriarty F, Ryan C, Smith SM, Bennett K, Fahey T, Wallace E, Cahir C, Williams D, Teeling M. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. Eur J Clin Pharmacol. 2016;72:583–91.CrossRefPubMedPubMedCentral Cooper JA, Moriarty F, Ryan C, Smith SM, Bennett K, Fahey T, Wallace E, Cahir C, Williams D, Teeling M. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. Eur J Clin Pharmacol. 2016;72:583–91.CrossRefPubMedPubMedCentral
16.
go back to reference Henning A, Wehrberger M, Madersbacher S, Pycha A, Martini T, Comploj E, Jeschke K, Tripolt C, Rauchenwald M. Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer? BJU Int. 2013;112:68–73.CrossRefPubMed Henning A, Wehrberger M, Madersbacher S, Pycha A, Martini T, Comploj E, Jeschke K, Tripolt C, Rauchenwald M. Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer? BJU Int. 2013;112:68–73.CrossRefPubMed
17.
go back to reference Hickner J, Graham D, Elder N, Brandt E, Emsermann C, Dovey S, Phillips R. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of family physicians National Research Network. Qual Saf Health Care. 2008;17:194–200.CrossRefPubMed Hickner J, Graham D, Elder N, Brandt E, Emsermann C, Dovey S, Phillips R. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of family physicians National Research Network. Qual Saf Health Care. 2008;17:194–200.CrossRefPubMed
19.
go back to reference Ladapo JA, Blecker S, Douglas PS. Physician decision making and trends in the use of cardiac stress testing in the united StatesAn analysis of repeated cross-sectional DataPhysician decision making and trends in the use of cardiac stress testing. Ann Intern Med. 2014;161:482–90.CrossRefPubMedPubMedCentral Ladapo JA, Blecker S, Douglas PS. Physician decision making and trends in the use of cardiac stress testing in the united StatesAn analysis of repeated cross-sectional DataPhysician decision making and trends in the use of cardiac stress testing. Ann Intern Med. 2014;161:482–90.CrossRefPubMedPubMedCentral
20.
go back to reference Lukachko A, Olfson M. Race and the clinical diagnosis of depression in new primary care patients. Gen Hosp Psychiatry. 2012;34:98–100.CrossRefPubMed Lukachko A, Olfson M. Race and the clinical diagnosis of depression in new primary care patients. Gen Hosp Psychiatry. 2012;34:98–100.CrossRefPubMed
21.
go back to reference Maeng DD, Martsolf GR, Scanlon DP, Christianson JB. Care coordination for the chronically ill: understanding the patient's perspective. Health Serv Res. 2012;47:1960–79.CrossRefPubMedPubMedCentral Maeng DD, Martsolf GR, Scanlon DP, Christianson JB. Care coordination for the chronically ill: understanding the patient's perspective. Health Serv Res. 2012;47:1960–79.CrossRefPubMedPubMedCentral
22.
go back to reference Maserejian NN, Link CL, Lutfey KL, Marceau LD, McKinlay JB. Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment. J Women's Health. 2009;18:1661–7.CrossRef Maserejian NN, Link CL, Lutfey KL, Marceau LD, McKinlay JB. Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment. J Women's Health. 2009;18:1661–7.CrossRef
23.
go back to reference Dodds A. The management of risks to patient safety and service quality in primary care: a review. London: King’s Patient Safety and Service Quality Research Centre; 2010. Dodds A. The management of risks to patient safety and service quality in primary care: a review. London: King’s Patient Safety and Service Quality Research Centre; 2010.
24.
go back to reference Hill AP, Freeman GK. Promoting continuity of care in general practice. London: Royal College of General Practitioners; 2011. Hill AP, Freeman GK. Promoting continuity of care in general practice. London: Royal College of General Practitioners; 2011.
25.
go back to reference Chang AM, Mumma B, Sease KL, Robey JL, Shofer FS, Hollander JE. Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk. Acad Emerg Med. 2007;14:599–605.CrossRefPubMed Chang AM, Mumma B, Sease KL, Robey JL, Shofer FS, Hollander JE. Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk. Acad Emerg Med. 2007;14:599–605.CrossRefPubMed
26.
go back to reference Hariz G-M, Hariz MI. Gender distribution in surgery for Parkinson's disease. Parkinsonism Relat Disord. 2000;6:155–7.CrossRefPubMed Hariz G-M, Hariz MI. Gender distribution in surgery for Parkinson's disease. Parkinsonism Relat Disord. 2000;6:155–7.CrossRefPubMed
27.
go back to reference Karim F, Islam MA, Chowdhury A, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. 2007;22:329–34.CrossRefPubMed Karim F, Islam MA, Chowdhury A, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. 2007;22:329–34.CrossRefPubMed
28.
go back to reference McMurray RJ, Clarke OW, Barrasso JA, Clohan DB, Epps CH, Glasson J, McQuillan R, Plows CW, Puzak MA, Orentlicher D. Gender disparities in clinical decision making. JAMA. 1991;266:559–62.CrossRef McMurray RJ, Clarke OW, Barrasso JA, Clohan DB, Epps CH, Glasson J, McQuillan R, Plows CW, Puzak MA, Orentlicher D. Gender disparities in clinical decision making. JAMA. 1991;266:559–62.CrossRef
29.
go back to reference Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329:326–31.CrossRefPubMed Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329:326–31.CrossRefPubMed
30.
go back to reference Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. Jama. 1993;269:2642–6.CrossRefPubMed Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. Jama. 1993;269:2642–6.CrossRefPubMed
31.
go back to reference Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.CrossRefPubMed Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.CrossRefPubMed
32.
go back to reference Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–9.CrossRefPubMed Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–9.CrossRefPubMed
33.
go back to reference Miller B, Campbell RT, Furner S, Kaufman JE, Li M, Muramatsu N, Prohaska T. Use of medical care by African American and white older persons: comparative analysis of three national data sets. J Gerontol Ser B Psychol Sci Soc Sci. 1997;52:S325–35.CrossRef Miller B, Campbell RT, Furner S, Kaufman JE, Li M, Muramatsu N, Prohaska T. Use of medical care by African American and white older persons: comparative analysis of three national data sets. J Gerontol Ser B Psychol Sci Soc Sci. 1997;52:S325–35.CrossRef
34.
go back to reference Roetzheim RG, Pal N, Tennant C, Voti L, Ayanian JZ, Schwabe A, Krischer JP. Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst. 1999;91:1409–15.CrossRefPubMed Roetzheim RG, Pal N, Tennant C, Voti L, Ayanian JZ, Schwabe A, Krischer JP. Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst. 1999;91:1409–15.CrossRefPubMed
35.
go back to reference Co-operation OfE, Development: Measuring up: improving health system performance in OECD countries. OECD Publishing; 2002. Co-operation OfE, Development: Measuring up: improving health system performance in OECD countries. OECD Publishing; 2002.
36.
go back to reference Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
37.
go back to reference Brännström J, Hamberg K, Molander L, Lövheim H, Gustafson Y. Gender disparities in the pharmacological treatment of cardiovascular disease and diabetes mellitus in the very old. Drugs Aging. 2011;28:993–1005.CrossRefPubMed Brännström J, Hamberg K, Molander L, Lövheim H, Gustafson Y. Gender disparities in the pharmacological treatment of cardiovascular disease and diabetes mellitus in the very old. Drugs Aging. 2011;28:993–1005.CrossRefPubMed
38.
go back to reference Metersky ML, Hunt DR, Kliman R, Wang Y, Curry M, Verzier N, Lyder CH, Moy E. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Med Care. 2011;49:504–10.CrossRefPubMed Metersky ML, Hunt DR, Kliman R, Wang Y, Curry M, Verzier N, Lyder CH, Moy E. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Med Care. 2011;49:504–10.CrossRefPubMed
39.
go back to reference Barakat K, Wells Z, Ramdhany S, Mills P, Timmis A. Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in East London, UK. Heart. 2003;89:276–9.CrossRefPubMedPubMedCentral Barakat K, Wells Z, Ramdhany S, Mills P, Timmis A. Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in East London, UK. Heart. 2003;89:276–9.CrossRefPubMedPubMedCentral
40.
go back to reference Lawton R, Parker D. Barriers to incident reporting in a healthcare system. Qual Safety Health Care. 2002;11:15–8.CrossRef Lawton R, Parker D. Barriers to incident reporting in a healthcare system. Qual Safety Health Care. 2002;11:15–8.CrossRef
42.
go back to reference Runciman B, Merry A, Smith AM. Improving patients' safety by gathering information: anonymous reporting has an important role. BMJ: British Medical Journal. 2001;323:298.CrossRefPubMed Runciman B, Merry A, Smith AM. Improving patients' safety by gathering information: anonymous reporting has an important role. BMJ: British Medical Journal. 2001;323:298.CrossRefPubMed
Metadata
Title
Social disparities in patient safety in primary care: a systematic review
Authors
Carlotta Piccardi
Jens Detollenaere
Pierre Vanden Bussche
Sara Willems
Publication date
01-12-2018
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-018-0828-7

Other articles of this Issue 1/2018

International Journal for Equity in Health 1/2018 Go to the issue