Patient and family engagement interventions on patients’ safety in primary care: a systematic review and meta-analysis

Abstract

AbstractBackgroundEngaging patients and their families has been proposed and promoted as key strategy in patient safety. However, little is known about the translation of such an approach in primary care. This systematic review and meta-analysis sought to assess the effectiveness of interventions promoting patient and family engagement for patient safety in primary care based on randomised controlled trials (RCTs).MethodsFive electronic databases (MEDLINE, CINAHL, Embase, Web of Science, and CENTRAL) were searched from inception to February 2023 with key words structured in four blocks (patient and family engagement; patient safety; primary care; randomised controlled trial). Two independent study team members screened each record. For studies reporting on similar safety outcomes, results were combined into meta-analyses. Risk of bias and level of certainty were accessed. Reporting followed PRISMA standards.ResultsSixteen records were identified, among which eight completed RCTs. Interventions covered “Inform about Engagement” and “Empower” levels regarding patient/family engagement but did not reach the highest level of “Partner/Integrate.” The interventions primarily targeted medication safety outcomes, with meta-analyses on adverse drug events and medication appropriateness (assessed categorically and continuously) showing no significant effects (Log OR=-0.32, 95%CI [-0.78, 0.14], OR=0.72, 95%CI [-0.32,0.16]; Log OR=-0.08, 95%CI [-0.32, 0.16], OR=0.92, 95%CI [0.73,1.17]; MD=0.56, 95%CI [-0.61, 1.72]). Overall risk of bias was low and the certainty of evidence ranged from moderate to high for most completed studies, except for adverse drug events, where certainty was rated low.ConclusionRCTs investigating interventions related to patient and family engagement in primary care patient safety are limited and yield inconclusive results. Patient engagement strategies should delve into more comprehensive levels of patient and family engagement and address diverse patient safety outcomes.What is already known on this topicInvolving patients and their families in patient safety has been advocated and emphasized as a crucial strategy. However, current reviews have yet to incorporate evidence evaluating the effectiveness of various intervention types and their impact on safety outcomes in the primary care setting.What this study addsThis review provides a synthesis of available RCTs examining the effects of interventions on patient and family engagement and their impact on patient safety within the primary care context.How this study might affect research, practice or policyThe findings from the review indicate that interventions targeting patient and family engagement did not exhibit a discernible impact on patient safety outcomes in the primary care setting. This underscores the imperative for more rigorous evaluations within this domain.