“When moving abroad people should consider a regular place of care”

ExpatHealth.org spoke to Harvard researcher Dr. Christine Lu about her recent study on medical error. Dr. Lu discussed common risk factors across countries and advised expats how to reduce their chances of experiencing medical error.

Based on your research can we draw any larger conclusions about the effectiveness or efficiency of different health systems?

I would be leery of comparing countries across the board in terms of pure numbers. This project studied medical error from the patient’s perspective—not provider type or health system. There are only a few percentage points between the countries with the highest and lower error rates. Instead of the numbers it would be more meaningful to look at the underlying risk factors: the differences and similarities across countries.

So what are some of those key similarities?

Patient management involves a cascade of factors and people and how they interact with each other along the process of care delivery. What I learned from my study is that there are at least three factors influencing patient safety that are shared across countries. First, the people involved in patient care; communication between multiple providers at different care sites, especially across care settings (for example, hospital to community settings), communication with the patient and careers etc. Second, the efficient transfer of medical information, computerized or not, across care settings and across multiple providers. Third, the complexity of the patient himself is also critical—the severity of his condition, co-existing conditions, the complexity of treatment regimens.

Medication error is a complex issue. If we target only one dimension of care delivery on its own–for example, have every country in the world implement electronic health records–would that reduce error to zero? No, I don’t think so.

If coordinating care is a key issue, what can expats do to reduce their risk of medical error, especially in foreign health systems where they may have difficulty communicating with their doctors or across treatment cultures?

When moving abroad they should consider a regular place of care. Especially finding a regular doctor they trust, who is familiar with their type of health insurance and coverage as well as their condition(s) and medical history. That way they have someone that can communicate on their behalf across the health system.

Do you have any plans to follow up on this study?

Not in terms of a direct follow-up at present. It would be interesting to study factors influencing patient safety from a different perspective, such as the health system. Or it would be valuable to expand survey questions to capture the consequences of errors experienced by patients. My research continues to focus on medication use and patient outcomes.

Dr. Christine Lu is a pharmacist, pharmacoepidemiologist, and Instructor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. Dr. Lu has extensive experience in quasi-experimental research designs for drug policy evaluation, pharmacology, and longitudinal data analysis. Homepage