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Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety

  • Systematic Review
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Abstract

Background

Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety.

Methods

We searched MEDLINE, EMBASE, reference lists and websites to August 2016. Two investigators independently reviewed all abstracts and articles, and articles were additionally reviewed by two senior investigators for selection. One investigator abstracted data and two investigators reviewed the data for accuracy. Study quality was determined by consensus. Investigators developed a framework for defining the level of patient engagement: informing patients about medications (Level 1), informing about engagement with health care providers (Level 2), empowering patients with communication tools and skills (Level 3), partnering with patients in their care (Level 4), and integrating patients as full care team members (Level 5).

Results

We included 19 studies that mostly targeted older adults taking multiple medications. The median level of engagement was 2, ranging from 2–4. We identified no level 5 studies. Key themes for patient engagement strategies impacting medication safety were patient education and medication reconciliation, with a subtheme of patient portals. Most studies (84%) reported implementation outcomes. The most commonly reported medication safety outcomes were medication errors, including near misses and discrepancies (47%), and medication safety knowledge (37%). Most studies (63%) were of medium to low quality, and risk of bias was generally moderate. Among the 11 studies with control groups, 55% (n = 6) reported statistically significant improvement on at least one medication safety outcome. Further synthesis of medication safety measures was limited due to intervention and outcome heterogeneity.

Conclusions

Key strategies for engaging patients in medication safety are education and medication reconciliation. Patient engagement levels were generally low, as defined by a novel framework for determining levels of patient engagement. As more patient engagement studies are conducted, this framework should be evaluated for associations with patient outcomes.

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Author information

Authors and Affiliations

  1. Johns Hopkins University, 200 N Wolfe St, Rubenstein Building, Room 2095, Baltimore, MD, 21287, USA

    Julia M. Kim, Catalina Suarez-Cuervo, Zackary Berger, Joy Lee, Jessica Gayleard, Carol Rosenberg, Natalia Nagy, Kristina Weeks & Sydney Dy

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Contributions

All authors agree to be accountable for all aspects of work, ensuring integrity and accuracy of this systematic review. JK contributed to the conception, design, data acquisition, analysis, and interpretation of the data, drafted the initial manuscript, provided critical revisions, and approved the final version. She also acts as overall guarantor for this work. CS-C contributed to the conception, design, data acquisition, analysis, and data interpretation, drafted methods, critically revised the manuscript, and approved the final version. ZB and JL contributed to the conception, design, data acquisition, analysis, and interpretation of the data, critically revised the manuscript, and approved the final version. JG and CR contributed to data acquisition and analysis of the data, critically revised the manuscript, and approved the final version. NN contributed to data acquisition, assisted with drafting figures and tables, critically revised the manuscript, and approved the final version. KW contributed to the conception, design, and data acquisition, critically revised the manuscript, and approved the final version. SD contributed to the conception, design, data acquisition, analysis, and interpretation of the data, critically revised the manuscript, provided content and methodologic expertise, and approved the final version.

Corresponding author

Correspondence to Julia M. Kim.

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Conflicts of interest

Drs. Julia Kim, Catalina Suarez-Cuervo, Zackary Berger, Joy Lee, Carol Rosenberg, and Sydney Dy, as well as Jessica Gayleard, Natalia Nagy, and Kristina Weeks have no conflicts of interest to declare.

Funding

MITRE funded the systematic review, although they did not have any role in the design and conduct of the study, including study selection, quality assessment, data synthesis, and manuscript preparation. The investigators are solely responsible for the content.

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Kim, J.M., Suarez-Cuervo, C., Berger, Z. et al. Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety. Patient 11, 193–206 (2018). https://doi.org/10.1007/s40271-017-0270-8

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