Global burden of preventable medication-related harm in health care: a systematic review

A series of WHO initiatives, such as the Global Patient Safety Challenge: Medication Without Harm and the Global Patient Safety Action Plan 2021-2030, address patient harm associated with use of medications. Medication-related harm is considered preventable if it occurs as a result of an identifiable,modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines. Understanding the prevalence, natureand severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety. This report presents an updated systematic review and meta-analysis of studies of the prevalence, nature and severity of preventable medication-related harm in theinternational literature including in low- and middle-income countries (LMICs). A total of 100 studies were included in the review, involving 487 162 patients. Ofthese reports, 70 were from high-income countries (HICs) and 30 from LMICs. The results were as follows. Global prevalence and severity of preventablemedication-related harm: The pooled prevalence of preventable medication-related harm in all 100 studies was 5% (1 in 20 patients). One fourth of the harm was severe or potentially life-threatening. Geographical distribution of preventable medication-related harm: The prevalence of preventable medication-related harm was 7% in 30 studies in LMICs and 4% (3–5%, one in 25 patients) in 70 studies in HICs. The highest prevalence rates of preventable medication-related harm were in the African (9%) and South-East Asian regions (9%). Health care settings in which the most vulnerable patients are managed for preventable medication-related harm: Globally, the highest prevalence ratesfor preventable medication-related harm are for patients managed in geriatric care units (17%) and among patients in highly specialized or surgical care (9%).Stages of medication at which most preventable medication-related harm occurs: Globally about half (53%) of all preventable medication-related harmoccurred at the “ordering/prescribing” stage and 36% at the monitoring/reporting” stage. In LMICs, almost 80% of preventable medication-related harm occurred during the “ordering/prescribing” stage. Medicines that contribute most to medication- related harm: Antibacterials, antipsychotics,cardiovascular medications, drugs for functional gastrointestinal disorders, endocrine therapy, hypnotics, sedatives and non-steroidal anti-inflammatory products contributed most to medication-related harm globally.Way forward: The analysis showed that at least one in 20 patients are affected by preventable medication-related harm globally and that more than one fourthof preventable harm is severe or life-threatening. The prevalence of preventable medication-related harm in LMICs was almost twice as high as in HICs;however, few data were available on the severity and nature of medication-related harm in LMICs. A prerequisite for the success of future strategiesto mitigate preventable medication-related harm in LMICs would be to encourage reporting of any preventable medication-related harm and commission high-quality studies with standard methods for assessing and reporting such harm and also studies of the underlying causes for designing interventions that are most likely to work in LMICs. There is also an urgent need to implement improvement strategies in settings in which patients are managed, especially those who are vulnerable to preventable medication related harm, such as geriatric care and surgical care settings. Finally, most of the evidence summarized in this report was produced in hospitals and should be strengthened with more research in major specialties, including primary care, and mental health

Hearing health geography in England:findings from the English longitudinal study of ageing (ELSA) and evidence of a north-south divide

Objective:To explore regional patterns and trends of hearing loss (HL) in a representative longitudinal prospective cohort study of the English population aged 50 years and above.Method:We used the full dataset (74,699 person-years) of the English Longitudinal Study of Ageing (ELSA). We examined the geographical identifiers of the participants at Geographical Office Regions (GOR) level, and the geographically based Index of Multiple Deprivation (IMD). We computed Adjusted Predictions at the Means (APMs) and the Marginal Effects at the Means (MEMs) of the HL prevalence in each ELSA Wave, with age, gender, education, occupation, income, wealth, IMD and alcohol consumption as the factor variables.Results:Between 2002-2017 there was an estimated increase of 10.2% in the total HL prevalence in the English older population: 38.50 (95%CI 37.37-39.14) in Wave 1, to 48.66 (95%CI 47.11-49.54) in Wave 8. The Hot Spot and Cold Spot analyses showed marked regional variability and evidence of a North-South divide. There was a wide variation in HL prevalence in representative samples from different regions in England that had similar age profiles, and the increase rate of HL ranged from 3.2% to 45%.Implications:These results provided evidence that the increasing trend in HL prevalence is not related to the ageing of the population, as widely believed, as the samples had significantly equal age but differed markedly on their HL outcomes, both regionally and chronically. A socio-spatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities

Managing diagnostic uncertainty in primary care: A systematic critical review

Abstract Background Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. Methods Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. Results Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses. Ethical aspects of uncertainty management centered on communicating diagnostic uncertainties with patients. Personality traits and characteristics influenced each of the three domains. Conclusions There is little empirical evidence on how uncertainty is managed in general practice. However we highlight how the extant literature can be conceptualised into cognitive, emotional and ethical aspects of uncertainty which may help clinicians be more aware of their own biases as well as provide a platform for future research. Trial registration PROSPERO registration: CRD4201502755

GPs' perceptions of resilience training: a qualitative study.

BACKGROUND: GPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care. AIM: To explore GPs' perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes. DESIGN AND SETTING: This was a qualitative study of the perspectives of GPs currently practising in England. METHOD: GPs were recruited through convenience sampling, and data were collected from two focus groups (n = 15) and one-to-one telephone interviews (n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis. RESULTS: Participants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues. CONCLUSION: A multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience

Income Inequality and Subjective Well-Being : A Systematic Review and Meta-Analysis

Background: Reducing income inequality is one possible approach used by some governments to boost subjective well-being (SWB). Nevertheless, previous studies have reported positive, null and negative associations between income inequality and SWB. Objectives: This study reports the first systematic review and meta-analysis of the relationship between income inequality and SWB, and seeks to understand the heterogeneity in the literature. Methods: This systematic review was conducted according to guidance (PRISMA and Cochrane Handbook) and searches (between January 1980 and October 2017) were carried out using Web of Science, Medline, Embase and PsycInfo databases. Results: 39 studies were included in the review, but poor data reporting quality meant that only 24 studies were included in the meta-analysis. The narrative analysis of 39 studies found negative, positive and null associations between income inequality and SWB. The meta-analysis confirmed these findings. The overall association between income inequality and SWB was almost zero and not statistically significant (pooled r = -0.01, 95% CI = -0.08 to 0.06; Q = 563.10, I² = 95.74 %, p < 0.001), suggesting no association between income inequality and SWB. Subgroup analyses showed that the association between income inequality and SWB was moderated by the country economic development (i.e., developed countries: r = -0.06, 95% CI = -0.10 to -0.02 versus developing countries: r = 0.16, 95% CI = 0.09 to 0.23). The association between income inequality and SWB was not influenced by: (a) the measure used to assess SWB, (b) geographic region, or (c) the way income inequality was operationalised. Conclusions: The association between income inequality and SWB is complex and moderated by the country economic development