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Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis
Maria Panagioti1, Jonathan Stokes2, Aneez Esmail2
1NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
Background:
Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care.
Methods:
We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: 'active patient safety incidents' (such as adverse drug events and medical complications) and 'precursors of safety incidents' (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken.
Results:
Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for 'active patient safety incidents' (OR = 2.39, 95% CI = 1.40 to 3.38) and 'precursors of safety incidents' (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low.
Conclusions:
The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
Insights
Multimorbidity, especially with mental health conditions, increases patient safety risks in primary care. This includes adverse events and errors, highlighting the need for targeted interventions to improve care for these complex patients.
Area of Science:
- Primary Care Research
- Patient Safety Science
- Health Services Research
Background:
- Multimorbidity is a growing challenge in primary care, increasing patient vulnerability to safety incidents.
- Existing research lacks comprehensive reviews on the link between multimorbidity and patient safety incidents.
- This review addresses the critical need to understand this relationship in the primary care setting.
Purpose of the Study:
- To examine the relationship between multimorbidity and patient safety incidents in primary care.
- To synthesize evidence on how different types of multimorbidity affect various patient safety outcomes.
- To identify implications for interventions aimed at improving safety for patients with multiple conditions.
Main Methods:
- Systematic review and meta-analysis of studies identified through Medline, Embase, and CINAHL up to May 2015.
- Calculation of odds ratios (OR) and 95% confidence intervals (95% CIs) for associations between multimorbidity and safety outcomes.
- Categorization of safety outcomes into 'active patient safety incidents' and 'precursors of safety incidents'.
Main Results:
- Eighty-six comparisons from 75 studies were analyzed.
- Physical-mental multimorbidity showed increased risk for active safety incidents (OR=2.39) and precursors (OR=1.69).
- Physical multimorbidity increased risk for active incidents (OR=1.63) but not precursors (OR=1.02). High heterogeneity and low study quality were noted.
Conclusions:
- The link between multimorbidity and patient safety is complex, varying by condition type and incident category.
- Multimorbidity involving mental health appears to be a significant driver of safety incidents.
- Further high-quality research is needed to elucidate mechanisms and inform safety interventions for multimorbid patients.
