Unintended harm: A qualitative study of “harm” upon people who inject drugs in Bangkok, Thailand

Given the highly pervasive health threats faced by people who inject drugs, harm reduction has been implemented in Thailand. Although harm reduction is a particularly effective public health strategy for reducing risky behavior, it is currently practiced with minimal understanding of unintended harm—drug policy, social exclusion, stigma, and discrimination—for people who inject drugs (PWID) in Thailand. This study aims to understanding the “unintended harm” encountered by people who inject drugs in Bangkok in their everyday lives through social interaction at all levels of society from macro, micro, and individual levels. In-depth interviews were conducted with 28 people who inject drugs in Bangkok (21 men and 7 women) and 4 people who are a nurse, a community leader, a policeman, and a family member (2 men and 2 women). The result shows that individuals, society, and politics are not separable phenomena and all produce harm upon people who inject drugs. These unintended harms on the macro, micro, and individual level are closely linked; each in their own way poses a threat to the health and well-being of people who inject drugs and embody negative social responses as the people who inject drugs become typecast as “deviants.” In conclusion, there is an urgent need to develop a “harm reduction” model that addresses unintended harm and could be integrated within the existing socio-cultural context of Thai society.

Complementary Medicine – Who Are We to Judge?

Dr. Alderman implores pharmacists to approach the prevalence of patients taking complimentary and using alternative therapies with logic over judgement, and, to see that an opportunity exists for the profession to be brokers of sensible, precautionary information that may protect their patients from serious unintended harm.

Conclusion

This concluding chapter argues that guilds did redistribute resources to their members at the expense of everyone else; they did not generate countervailing benefits by solving failures in markets for quality, training, or innovation; and they did inflict unintended harm on the wider economy. In practice, markets are never perfect and states are never impartial, and this was undoubtedly true of the markets and states of pre-modern Europe. However, guilds made little contribution to correcting market or state failures. By seeking rents for their own members, guilds intensified market failures, sometimes deliberately, sometimes inadvertently. They also contributed to making governments even more corrupt than they already were by offering an effective institutional mechanism whereby two powerful groups, guild members and political elites, could collaborate in capturing a larger share of resources at the expense of the rest of the economy.

Improving patient safety through the involvement of patients: development and evaluation of novel interventions to engage patients in preventing patient safety incidents and protecting them against unintended harm

BackgroundEstimates suggest that, in NHS hospitals, incidents causing harm to patients occur in 10% of admissions, with costs to the NHS of > £2B. About one-third of harmful events are believed to be preventable. Strategies to reduce patient safety incidents (PSIs) have mostly focused on changing systems of care and professional behaviour, with the role that patients can play in enhancing the safety of care being relatively unexplored. However, although the role and effectiveness of patient involvement in safety initiatives is unclear, previous work has identified a general willingness among patients to contribute to initiatives to improve health-care safety.AimOur aim in this programme was to design, develop and evaluate four innovative approaches to engage patients in preventing PSIs: assessing risk, reporting incidents, direct engagement in preventing harm and education and training.Methods and resultsWe developed tools to report PSIs [patient incident reporting tool (PIRT)] and provide feedback on factors that might contribute to PSIs in the future [Patient Measure of Safety (PMOS)]. These were combined into a single instrument and evaluated in the Patient Reporting and Action for a Safe Environment (PRASE) intervention using a randomised design. Although take-up of the intervention by, and retention of, participating hospital wards was 100% and patient participation was high at 86%, compliance with the intervention, particularly the implementation of action plans, was poor. We found no significant effect of the intervention on outcomes at 6 or 12 months. The ThinkSAFE project involved the development and evaluation of an intervention to support patients to directly engage with health-care staff to enhance their safety through strategies such as checking their care and speaking up to staff if they had any concerns. The piloting of ThinkSAFE showed that the approach is feasible and acceptable to users and may have the potential to improve patient safety. We also developed a patient safety training programme for junior doctors based on patients who had experienced PSIs recounting their own stories. This approach was compared with traditional methods of patient safety teaching in a randomised controlled trial. The study showed that delivering patient safety training based on patient narratives is feasible and had an effect on emotional engagement and learning about communication. However, there was no effect on changing general attitudes to safety compared with the control.ConclusionThis research programme has developed a number of novel interventions to engage patients in preventing PSIs and protecting them against unintended harm. In our evaluations of these interventions we have been unable to demonstrate any improvement in patient safety although this conclusion comes with a number of caveats, mainly about the difficulty of measuring patient safety outcomes. Reflecting this difficulty, one of our recommendations for future research is to develop reliable and valid measures to help efficiently evaluate safety improvement interventions. The programme found patients to be willing to codesign, coproduce and participate in initiatives to prevent PSIs and the approaches used were feasible and acceptable. These factors together with recent calls to strengthen the patient voice in health care could suggest that the tools and interventions from this programme would benefit from further development and evaluation.Trial registrationCurrent Controlled Trials ISRCTN07689702.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.