Effectiveness of interventions designed to promote patient involvement to enhance safety: a systematic review

Abstract

Background: There is growing international interest in involving patients in interventions to promote and support them in securing their own safety. This paper reports a systematic review of evaluations of the effectiveness of interventions that have been used with the explicit intention of promoting patient involvement in patient safety in healthcare. Methods: The authors searched Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CENTRAL, CINAHL, EMBASE, HMIC, MEDLINE, MEDLINE in-process, PsycINFO and ASSIA to August 2008. We also searched databases of reports, conference proceedings, grey literature, ongoing research and relevant patient safety organisations, and hand-searched two journals. Meta-analysis of the data was not appropriate; therefore, studies were categorised according to how the interventions encouraged patients' actions to improve safety-informing the management plan, monitoring and ensuring safe delivery of treatment (by health professional and by self), making systems safer-and were critiqued in a narrative manner. Findings: The authors identified 14 individual experimental and quasiexperimental studies plus one systematic review. The majority of studies fell into the monitoring and ensuring safe delivery of treatment by self category and were all related to enhancing medication safety. Authors reported improved patient safety incident outcomes for the intervention groups compared with controls where the interventions aimed to encourage patient involvement in: (1) monitoring and ensuring safe delivery of treatment by self (self-management of anticoagulation, 'easy' read information leaflet, nurse-led education to promote self-medication in hospital, patient package insert using lay terminology); (2) informing the management plan/monitoring and ensuring safe delivery of treatment by self (individualised teaching plan by nurse, pharmacist counselling). It was not possible to draw any clear conclusions as to the effectiveness of the interventions (with the exception of one specific aspect of self-medication, that is, self-management of anticoagulation) due to concerns about the methodological quality of the studies. Conclusions: There is limited evidence for the effectiveness of interventions designed to promote patient involvement on patient safety incidents and in general is poor quality. Existing evidence is confined to the promotion of safe self-management of medication, most notably relating to the self-management of oral anticoagulants

Patient Involvement in Patient Safety: Current experiences, insights from the wider literature, promising opportunities?

“…It included systematic reviews of articles on the most effective ways of engaging the public in patient safety and evidence scans or reviews of the type and extent of patient involvement that might be considered in patient safety Hall et al 2010;Doherty and Stavropoulou 2012;Ward and Armitage 2012;Coulter and Ellins 2007;Schwappach 2010;Davis et al 2012). Such reviews tended not to offer much evidence for the effectiveness of patient and public involvement in patient safety; reviews by the Health Foundation (2013) and Hall et al (2010) struggled to determine from the extant literature what works best in engaging patients in terms of safety outcomes. One review, confined to patient involvement in medication safety, did find some evidence for the effectiveness of a patient involvement intervention in one area -self-management of anti-coagulationbut found little evidence of effectiveness for other types of intervention .…”

Safety as Experienced by Patients Themselves: A Finnish Survey of the Most Recent Period of Care

“…Several investigators have pointed out that little is known about patients' willingness and ability to adopt patient-safety-promoting behaviors (Davis, Jacklin, Sevdalis, & Vincent, 2007;Entwistle, 2007;Hall et al, 2010). Some findings suggest that patients strongly support having an active role in error prevention (Schwappach, 2010;Waterman et al, 2005).…”

“…Recently, however, there has been growing interest in involving patients in the promotion of safer care, including supporting patients to take responsibility for their own safety (Entwistle, 2007;Hall et al, 2010). These factors have been recognized in many countries as key elements of patient safety (Finnish Patient Safety Strategy, 2009;Kohn, Corrigan, & Donaldson, 2000).…”

Towards safer care in Sweden? : Studies of influences on patient safety

“…There is also a paucity of research on how the patients accept their new role (Longtin et al 2010;Byrd and Thompson 2008). More research is needed to progress from rhetoric to practice, in order to develop strategies for improving patients' involvement in their own care (Ward et al 2011;Hall et al 2010;Davis et al 2011;). …”