Patient and family engagement interventions in primary care patient safety: systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Engaging patients and families has been promoted as a key strategy for improving patient safety of health systems. However, evidence remains scarce on the effectiveness of this approach in primary care.

Aim: To assess the combined effectiveness of primary care interventions in randomised controlled trials (RCTs) promoting patient and family engagement in patient safety.

Design and setting: A systematic review and meta-analysis.

Method: The review followed PRISMA and Cochrane guidelines. Five electronic databases (Medline, CINAHL, Embase, Web of Science, CENTRAL) were searched from inception to 18 September 2024 with keywords in four blocks (patient and family engagement; patient safety; primary care; randomised controlled trial). Patient and family engagement levels were appraised. Where appropriate, results were combined into meta-analyses.

Results: Of the 19 included records, 12 reported on completed RCTs. Only one intervention integrated patients/families into overall care safety (high engagement); six aimed at enhancing skills and tools (intermediate), and 12 informed patients/families how to engage and prompted them to do it (low). RCTs primarily targeted medication safety, with meta-analyses showing no significant effects on reducing adverse drug events (odds ratio [OR] 0.86, 95% confidence interval [CI] = 0.70 to 1.08) or improving medication appropriateness measured categorically (OR 0.92, 95% CI = 0.76 to 1.13) or continuously (mean difference 0.71, 95% CI = -0.10 to 1.52). Overall risk of bias was low and certainty of evidence very low to moderate.

Conclusion: Existing randomised controlled evidence on patient and family engagement in primary care remains inconclusive and limited in scope. Future interventions should include higher levels of engagement and address more diverse patient safety outcomes relevant for primary care.

Keywords: family engagement; family involvement; family medicine; patient engagement; patient involvement; patient participation; patient safety; primary health care; randomised controlled trial.

Figure 1

PRISMA Chart summarising the screening process. RCT = randomised controlled trial.

Figure 2

Interventions classified by level of patient and family engagement.

Figure 3

Meta-analyses of RCTs and cluster RCTs included in the review. CI = confidence interval. MD = mean difference. OR = odds ratio. RCT = randomised controlled trial. SE = standard error. Dotted vertical line and grey diamond = overall measure of effect.