Diagnostic Errors in Low and Middle-Income Countries: Future Health and Economic Burden for Patient Safety

Mahumud RA^1*,2, Sultana M¹, Sheikh N¹, Ali MN¹, Mitra DK² and Sarker AR¹

¹Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

²School of Public Health, Independent University, Bangladesh

*Corresponding author: Rashidul Alam Mahumud, Health Economics and Financing Research, Health System and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh

Received: November 03, 2016; Accepted: November 11, 2016; Published: November 14, 2016

Editorial

Diagnostic error is one of the leading causes of medical malpractice resulting an under recognized patient safety concern [1,2]. Moreover, the health burden has been expanded heavily due to diagnostic error in the past few decades. Globally, an estimated 94,000 -142,000 people died from 1990 to 2013 from adverse effects of diagnostic errors [3]. In developed countries experience ~850,000 diagnostic errors each year; that leads to huge health and economic burden [1]. It is also a rising burden of diagnostic error faced by low- and middle-income countries (LMICs) [4,5]. Whereas compounded through experiences of limited health care infrastructure, disappointingly trained health workforce as well as inappropriate health facilities has significantly contributed to the low quality of health services in LMICs [4]. However, affordability to acquire medicines and access to adequate health care remains a barrier for the people with LMICs while diagnostic error that leads to wrong treatment creates an additional health and economic burden. Regarding the disease patterns, it has been shifted remarkably from communicable to Non-communicable disease accompanied with socioeconomic progress in LMICs [6] due to epidemiological transition attributed by the emerging magnitude of chronic and degenerative diseases. The burden of NCDs accounted for 86% and 37% for high-income and low-income countries respectively in 2008, while it has been assumed to be raised unto one-half of the disease burdens by 2030 indicating NCDs as growing concerns for LMICs [4,6,7]. However, children and elderly are suffered more due to infectious and parasitic diseases and caused a major share of disease burden for LMICs. On the other hand, non-communicable disease (NCD), comprising cardiovascular disease, diabetes, stroke, and chronic pulmonary diseases, has been contributing to increasing patient health burden due to diagnostic error rapidly in LMICs [4,7].

The World Health Organization (WHO) recently prioritized patient safety areas strengthening in primary health care addressing the consequences of diagnostic error, especially for LMICs [8].

A diagnostic error is any mistake or failure in the diagnostic procedure leading to a misdiagnosis, a delayed diagnosis, or a missed diagnosis [9]. It can be considered ‘missed’ (no diagnosis like as patient missed at different care appointments alarming symptoms), ‘wrong’ (incorrect diagnosis was completed prior to the true diagnosis) or ‘delayed’ (the necessary information to make the diagnosis was available earlier) [9,10]. However, it is difficult to determine the three; missed and wrong scenarios, and delayed diagnosis. The evolution of diagnoses over time generally formulates it challenging to isolate a diagnostic error considering the definitions and dimensions. In addition, the diagnostic course can also expand across various providers and in different surroundings [10]. On the other hand, there are no standard guidelines for ‘timely’ diagnosis for the mainstream of patient health conditions [11].

Diagnostic errors occur from the three different contributing causes such as cognitive errors related to faulty data gathering (Figure 1), faulty information processing and faulty metacognition; systems causes linked to availability and functioning of medical equipment and connection between different practitioners into the health care system [9,12].

Figure 1: Flowchart for diagnostic error.

    
    
    Figure 1:  Flowchart for diagnostic error.

Furthermore, different no-fault causes derived from the related to unusual/silent presentation of disease, inconsistent/confusing description from patient, uncooperative patient, limitations of current medical knowledge and failure to arrive at correct diagnosis despite doing the right thing [9,12]. Earlier study found that diagnostic errors has been dominated by cognitive errors (74%) compared with the system errors (65%), however, only 7% through no-fault errors [12].

Diagnosis error might have potential impact on illness, casualty, disability and death which are avoidable and also facing the serious allegations in health platform in LMICs [5,13]. Additionally, inappropriate uses of medicines as a consequence of misdiagnosis might reduce the treatment effectiveness to a great extent [12]. The absence of active public health law and inadequate monitoring, and, in addition to speedy commercialization of healthcare is the leading cause of deterioration of the health care system where patients and patient’s family suffers more as a consequence [13]. Furthermore, the limited treatment opportunities have become more expensive and less effective; the clinical outcome and economic expenses due to diagnostic errors are significantly making additional burden to the patients household [14]. The additional medical and non-medical expenses due to diagnostic errors that can further expand ahead of the patients whose bad situations are misdiagnosed and may directed to poverty.

Some specific diagnostic errors such as disappointment to accurately identify infectious disease or recognize mental illness in people with the diagnosis were missed, although also potentially many others with whom that person comes in contact. Although pulmonary embolism and stroke are the most common misdiagnosed conditions, however, a number of patients affected through a misdiagnosed for communicable diseases such as HIV infection that might be greater than non-communicable diseases [15]. This type of misdiagnosis for the communicable disease could bring a serious threat to public health worldwide that would also raise the health challenges. Without an uncertainty, the growing virulence and resistance of universal pathogens additional amplify the threat that the misdiagnosis of patients will consequence in broad adverse effects for others. The increasing multidrug-resistant pathogens that breakdown to accurately and quickly diagnose communicable infection has a greater network impact.

More specifically, the tools available for tracking and preventing diagnostic errors, like health information technology (HIT) were less complicated [4]. Advance in HIT recommends new instruments for measuring and reducing diagnostic errors; the authors would suggest developing a proper guideline to train personnel adequately about diagnoses. Central authorities, donor agencies or private foundations could allocate more customized funding for the study and for programs implementation. Furthermore authors also suggest for the root cause analysis to identify the appropriate causes regarding the errors for different clinical conditions; explain downstream of the health condition; and to specify associated factors such as provider, patient, and also associated health system factors that could have impact in reducing rates of diagnosis error as well as to encourage research and improvement in this context.

In summary, actively clinical acknowledge and attend to the growing health and economic costs for regarding diagnostic errors which might to spot a significant opportunity to provide better care for patients and understand better financial performance designed for health systems to saving of lives, yield significant global health benefits especially in LMICs which might help to accomplish universal health coverage.

References

Download PDF

Citation: Mahumud RA, Sultana M, Sheikh N, Ali MN, Mitra DK and Sarker AR. Diagnostic Errors in Low and Middle-Income Countries: Future Health and Economic Burden for Patient Safety. Austin Emerg Med. 2016; ISSN : 2473-0653

Instruction for Authors

Submit Your Article