Johns Hopkins University, 200 N Wolfe St, Rubenstein Building, Room 2095, Baltimore, MD, 21287, USA.
Patient. 2018 Apr;11(2):193-206. doi: 10.1007/s40271-017-0270-8.
Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety.
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).
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.
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.
患者和家属的参与（PFE）对患者安全至关重要。我们系统地回顾了实施的 PFE 策略的类型及其对药物安全的影响。
我们检索了 MEDLINE、EMBASE、参考文献列表和网站，检索时间截至 2016 年 8 月。两名调查员独立审查了所有摘要和文章，两名资深调查员还对文章进行了审查以确定选择。一名调查员提取数据，两名调查员审查数据的准确性。通过协商确定研究质量。调查员制定了一个定义患者参与程度的框架：告知患者有关药物的信息（第 1 级）、告知患者与医疗保健提供者的互动（第 2 级）、用沟通工具和技能赋予患者权力（第 3 级）、与患者合作进行护理（第 4 级）、并将患者整合为完整的护理团队成员（第 5 级）。
我们纳入了 19 项研究，这些研究主要针对服用多种药物的老年人。参与程度的中位数为 2 级，范围为 2-4 级。我们没有发现 5 级研究。影响药物安全的患者参与策略的主要主题是患者教育和药物重整，其亚主题是患者门户。大多数研究（84%）报告了实施结果。最常见的药物安全结果是药物错误，包括差点发生的错误和差异（47%）以及药物安全知识（37%）。大多数研究（63%）的质量为中低水平，偏倚风险普遍中等。在有对照组的 11 项研究中，有 55%（n=6）报告至少有一个药物安全结果有统计学意义的改善。由于干预措施和结果的异质性，对药物安全措施的进一步综合受到限制。
参与患者药物安全的关键策略是教育和药物重整。根据确定患者参与程度的新框架，患者参与水平普遍较低。随着更多的患者参与研究的开展，应评估该框架与患者结果的关联。
