Self-reported Medical, Medication and Laboratory Error in Eight Countries

Andrea Scobie

Int J Qual Health Care. 2011;23(2):182-186.

Abstract and Introduction

Abstract

Objective. To identify risk factors associated with self-reported medical, medication and laboratory error in eight countries.
Design. The Commonwealth Fund's 2008 International Health Policy Survey of chronically ill patients in eight countries.
Intervention. None.
Setting and Participants. A multi-country telephone survey was conducted between 3 March and 30 May 2008 with patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA who self-reported being chronically ill.
Main Outcome Measure. A bivariate analysis was performed to determine significant explanatory variables of medical, medication and laboratory error (P < 0.01) for inclusion in a binary logistic regression model.
Results. The final regression model included eight risk factors for self-reported error: age 65 and under, education level of some college or less, presence of two or more chronic conditions, high prescription drug use (four+ drugs), four or more doctors seen within 2 years, a care coordination problem, poor doctor–patient communication and use of an emergency department.
Conclusion. Risk factors with the greatest ability to predict experiencing an error encompassed issues with coordination of care and provider knowledge of a patient's medical history. The identification of these risk factors could help policymakers and organizations to proactively reduce the likelihood of error through greater examination of system- and organization-level practices.

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Table 1. Respondent demographics
Country	Total respondents, n	Experienced at least one error, %	Age		Sex		At least one chronic condition, %
Country	Total respondents, n	Experienced at least one error, %	18–64, %	65+, %	Male, %	Female, %	At least one chronic condition, %
Australia	750	24.0	67.5	32.5	35.2	64.8	79.1
Canada	2635	25.4	76.3	23.7	36.1	63.9	74.2
France	1202	16.0	68.3	31.7	30.4	69.6	70.8
Germany	1200	16.3	62.7	37.3	36.7	63.3	72.2
Netherlands	1000	17.9	60.5	39.5	35.2	64.8	73.6
New Zealand	751	22.8	76.3	23.7	35.8	64.2	69.0
UK	1200	19.8	61.3	38.7	34.3	65.7	77.8
USA	1205	32.1	67.8	32.2	34.5	65.5	83.6
All	9944	22.2	68.6	31.4	34.9	65.1	75.0

Table 2. Bivariate analysis results
Variable	Patients with error (n = 2211)^a, n (%)	Patients without error (n = 6933), n (%)	Signficance^b
Sex
Male	714 (32.3)	2428 (35.0)
Female	1497 (67.7)	4505 (65.0)	0.019*
Age
18–64 years	1707 (77.2)	4543 (65.5)
65+ years	504 (22.8)	2390 (34.5)	0.000
Education level
Some college or less	1619 (74.4)	5336 (78.3)
College graduation and higher	557 (25.6)	1481 (21.7)	0.000
Number of chronic conditions (including hypertension, heart disease, diabetes, arthritis, chronic lung problems, mental health problems and cancer)
1	1041 (47.5)	3651(53.0)
2+	1152 (52.5)	3241 (47.0)	0.000
Number of doctors seen in past 2 years
3 or less	1077 (50.2)	4651 (68.6)
4+	1070 (49.8)	2125 (31.4)	0.000
Care coordination problem (including information not available at the time of appointment, unnecessary medical tests and unnecessary treatments)
Yes	1235 (55.9)	1895 (27.5)
No	974 (44.1)	5000 (72.5)	0.000
Poor communication with doctor (including not knowing important medical history, not encouraging patient to ask questions, not involving patient in treatment decisions and not giving adequate care instructions)
Yes	1648 (77.3)	4464 (66.2)
No	484 (22.7)	2282 (33.8)	0.000
Prescription drug use on regular basis
3 or less	1301 (60.2)	4325 (63.4)
4+	859 (39.8)	2493 (36.6)	0.007
ED use in the past 2 years
Yes	1349 (61.9)	2976 (43.5)
No	829 (38.1)	3860 (56.5)	0.000

^aRespondents who self-reported experiencing a medication error, medical mistake or laboratory diagnostic mistake in the past 2 years.
^b χ ² test, two-side asymptotic P-value.
*Not significant at α = 0.01.

Table 3. Logistic regression model
Risk factor	Significance*	OR	95% Confidence interval
Age (65+)	0.000	0.618	0.541–0.705
Education (some college or less)	0.000	1.322	1.184–1.475
Chronic conditions (2+)	0.002	1.208	1.069–1.365
Number of doctors (4+)	0.000	1.810	1.623–2.019
Poor care coordination	0.000	2.675	2.399–2.983
Poor doctor communication	0.000	1.571	1.389–1.778
Prescription drug use (4+)	0.001	1.241	1.095–1.408
ED use	0.000	1.779	1.596–1.984

*χ ² test, P < 0.01.

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