25% of patients face harm in primary and ambulatory healthcare. What can we do?

Posted on: 14.08.2019
Doctor looking desperate

According to an OECD study from 2018, 1 in 4 patients is harmed while receiving primary and ambulatory healthcare. 2.6 million people die annually due to unsafe care. Medication errors cost an estimated 42 billion USD annually. Patient safety, in other words, patients’ lives, requires a “zero harm” policy in healthcare.

Saving money and unnecessary suffering

The report indicates that 134 million adverse events occur each year in hospitals, which absorbs about 5% of the healthcare expenditures on health. We all know that it’s impossible to lower this number to zero. The literature suggests that up to 85% of all harmful events occurring in primary and ambulatory care are preventable. Mistakes or oversights were always and will be a part of medicine – the most sophisticated science in the world. Delayed or wrong diagnoses, inappropriate treatments, medication errors – most of these result from a lack of data or so much that people can't process due to cognitive or time restrictions. Healthcare today is an enormous industry.

Given that health and well-being are getting even more critical for each individual, this won’t change. But with the right help of safety procedures, standards, evidence-based interventions, check-lists, check-ups and reminders, modern healthcare can make a shift from hospital-oriented care to a patient-oriented paradigm. We can do much more than we do today to deliver the best care and outcomes.

Patient-friendly ecosystem

Referring to the “The Economics of Patient Safety in Primary and Ambulatory Care”, five factors influence the quality of care: patients (empowerment and reporting), governance (regulation and incentives), human capital (education and investment), leadership and culture and information infrastructure (EHR and data interoperability. All are related to each other, and each should be considered at the top of the political agenda. Being realistic about the healthcare budget restrictions and some other limitations, some of the changes are hard to introduce. For example, the shortage of medical professionals is a chronic problem of all healthcare systems around the world. However, following the public debates, I get the impression that the investment focus in healthcare hasn’t changed for years. Hospitals pump money into the most modern medical equipment, but today, what is much more critical to guarantee the best decision making is information infrastructure, patient involvement and care coordination. Even if the resources are limited, these three factors can contribute to building safer care for all.  

To support doctors and motivate patients

How can you ensure prosperous agriculture without adequate hydration? Is it possible to secure economic development without a suitable road network? The answer is no. Sustainable healthcare is also unthinkable without data exchange. Thanks to technological advancements in digital health, the possibilities of avoiding unnecessary harm have expanded. Patients have access to health apps that deliver reliable instructions in areas like disease prevention, chronic disease management, rehabilitation etc. For example, the WHO has introduced the Medsafe app, which guides patients to reduce the risk of medication-related harm. This kind of solution should be an integral part of medical recommendations, the same as prescribing drugs. Even doctors need control and supervision. Artificial intelligence applications could expand their cognitive capabilities. Algorithms can become an extra pair of doctor’s eyes, so no essential details in an EHR or a medical image are ever overlooked. They should work like checklists to guide doctors when they are seeing their patients. And we know from history that checklist led to a massive decrease in death rates in hospitals. The WHO surgical checklist, introduced in 2009, resulted in significant reduction in both morbidity and mortality. Healthcare is too complicated to leave room for intuition or improvisation. Randomness cannot determine the patient's health and life.

We can better protect patients from diagnostic, treatment and medical errors. Statistics revealing the occurrence of patient harm are alarming, and probably the scale of this unexplored problem is actually even larger. Digital health offers a new toolbox helping us to reduce the scope of the problem.

Artur Olesch

Artur Olesch

Freelance Digital Health Journalist