Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety

Perception of Medication Safety-Related Behaviors Among Different Age Groups: Web-Based Cross-Sectional Study

BACKGROUND

Previous research and safety advocacy groups have proposed various behaviors for older adults to actively engage in medication safety. However, little is known about how older adults perceive the importance and reasonableness of these behaviors in ambulatory settings.

OBJECTIVE

This study aimed to assess older adults' perceptions of the importance and reasonableness of 8 medication safety behaviors in ambulatory settings and compare their responses with those of younger adults.

METHODS

We conducted a survey of 1222 adults in the United States using crowdsourcing to evaluate patient behaviors that may enhance medication safety in community settings. A total of 8 safety behaviors were identified based on the literature, such as bringing medications to office visits, confirming medications at home, managing medication refills, using patient portals, organizing medications, checking medications, getting help, and knowing medications. Respondents were asked about their perception of the importance and reasonableness of these behaviors on a 5-point Likert rating scale in the context of collaboration with primary care providers. We assessed the relative ranking of behaviors in terms of importance and reasonableness and examined the association between these dimensions across age groups using statistical tests.

RESULTS

Of 1222 adult participants, 125 (10.2%) were aged 65 years or older. Most participants were White, college-educated, and had chronic conditions. Older adults rated all 8 behaviors significantly higher in both importance and reasonableness than did younger adults (P<.001 for combined behaviors). Confirming medications ranked highest in importance (mean score=3.78) for both age groups while knowing medications ranked highest in reasonableness (mean score=3.68). Using patient portals was ranked lowest in importance (mean score=3.53) and reasonableness (mean score=3.49). There was a significant correlation between the perceived importance and reasonableness of the identified behaviors, with coefficients ranging from 0.436 to 0.543 (all P<.001).

CONCLUSIONS

Older adults perceived the identified safety behaviors as more important and reasonable than younger adults. However, both age groups considered a behavior highly recommended by professionals as the least important and reasonable. Patient engagement strategies, common and specific to age groups, should be considered to improve medication safety in ambulatory settings.

Patient and caregiver perspectives on causes and prevention of ambulatory adverse events: multilingual qualitative study

CONTEXT

Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute when engaged in ambulatory AE review, focusing on under-resourced care settings.

METHODS

We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants' perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes.

FINDINGS

The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects.

CONCLUSIONS

An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives.

Qualitative Comparison of Perceptions Regarding Patient Engagement for Patient Safety by Physicians, Nurses, and Patients

Purpose

Patient engagement in ensuring patient safety is widely acknowledged, there is still a need to explore how perceptions of patient engagement vary among different stakeholders within the healthcare system. We aimed to compare the perceptions regarding patient engagement for patient safety among physicians, nurses, and patients by exploring the perspectives.

Patients and Methods

A qualitative study, comprising three focus group discussions (six to eight people each), was conducted in South Korea. Physicians and nurses who worked at the general hospital level or higher, and patients who had been hospitalized for more than 24 hours, were included. Researchers analyzed the transcripts, and a content analysis was performed to describe influencing elements of patient engagement for patient safety. A word cloud was created through keyword analysis of the transcripts.

Results

Based on 479 coded data, three categories and eight sub-categories were derived. The first moment of patient engagement was viewed as the choice of medical institutions. Reputation occupied a large part in the hospital selection for all participants, but they did not know about or use the national hospital evaluation data. Participants said that continuous patient engagement, such as the patient's active questioning attitude, guardian's cooperation, sufficient medical personnel, and patient safety education was required during treatment. However, it was said that patient engagement was ignored after patient safety incidents occurred. They mentioned that they were emotional and busy arguing for their own positions, and that it was difficult to use a medical dispute resolution method in practice. In the word cloud by group, fall, explanation, hospital, and patient were common words.

Conclusion

All three groups agreed on the importance of patient engagement for patient safety but differed in its influencing factors. Efforts should be made to reduce the difference between the three groups on how to involve patients for patient safety.

Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial

BACKGROUND

Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources.

OBJECTIVE

This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety.

METHODS

The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits.

RESULTS

The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024.

CONCLUSIONS

This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57878.

Parents' perspectives on using a Family Medication Safety Plan designed to promote appropriate opioid prescription practices with adolescents

BACKGROUND

Research has underscored the vulnerability of adolescents to opioid misuse, creating a call to action for researchers and practitioners to identify ways to reduce the youths' risk of opioid misuse. Although strategies have previously been proposed, few studies have targeted and designed interventions for adolescents and their families. The Family Medication Safety Plan (FMSP) was developed to provide families with a tool to encourage early education and conversation and promote safe use of prescription opioid medications in their homes.

OBJECTIVES

This study aimed to understand parent perceptions of using the FMSP for potential opioid prescriptions and identify opportunities for widespread application and improvement.

METHODS

Parents living in the United States with access to a webcam-enabled computer were recruited via social media, e-mail listservs, snowball sampling, and Qualtrics research panels. Parents were given the FMSP and asked to complete the worksheet with their child aged 12-18 years. Parents were then scheduled for a 30-minute, semistructured interview to elicit feedback. Interviews were transcribed verbatim by professional transcriptionists before being uploaded to NVivo for thematic and content analysis.

RESULTS

Parents (N = 59) were interviewed and had positive impressions of using the FMSP in their homes. Prevalent themes identified included how the FMSP format could be modified and how the parents would use it in their family. Many participants identified ways in which different health care providers could be used as a resource to make the FMSP more accessible and useful for their family unit.

CONCLUSION

Parents indicated that the FMSP was a beneficial tool for integration and evaluation of safe medication practices in homes. Participants suggested that this tool was most valuable when used for the specific needs of each family, indicating that modifying the FMSP to make it in a more flexible format such that it may improve uptake.

The RESPECT-brochure: Development of a tool to inform and empower residents and informal caregivers on the medicines' pathway in nursing homes

Objective

To develop and evaluate a tool to inform and empower nursing home (NH) residents and informal caregivers regarding the medicines' pathway.

Methods

Feedback on the tool's text, drafted by the research team, was collected from a professional organization; the lay-out was designed by an illustrator. The tool was pilot tested in NHs, focusing on feasibility, appropriateness, and meaningfulness. Semi-structured interviews and focus groups with residents, informal caregivers, and healthcare professionals were performed, as well as document analysis. Qualitative data were analyzed inductively.

Results

The RESPECT-brochure was developed and described each process of the medicines' pathway. Piloting showed that the tool was well perceived among residents and informal caregivers and offered opportunities to discuss medication-related questions and concerns, but that skills to tailor the conversation, especially given the changing NH population, a matching vision and local champion are required for the tool's uptake.

Conclusion

An informative and empowering tool has been successfully developed and pilot tested in NHs. Future research should investigate which strategies for implementation work best and can explore the impact of the tool's use in daily practice.

Innovation

The tool is the first in its kind and grants nursing home staff a new strategy to promote person-centered care.

Review: Patient engagement in child, adolescent, and youth mental health care research - a scoping review

BACKGROUND

Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement.

METHOD

We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis.

RESULTS

Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample.

CONCLUSIONS

Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.

Pharmacists' Perceptions of Physician-Pharmacist Collaboration-A 2022 Cross-Sectional Survey in Poland

Patient-centered care requires close collaboration among multiple healthcare professionals, including physician-pharmacist collaboration (especially as a part of pharmaceutical care). This study aimed to assess pharmacists' perceptions of physician-pharmacist collaboration as well as to identify factors associated with the willingness to provide pharmaceutical care services in Poland. This questionnaire-based survey was carried out in 2022 among community pharmacists from one of the largest franchise chain pharmacy networks in Poland. Completed questionnaires were received from 635 community pharmacists (response rate of 47.9%). Almost all the pharmacists agreed with the statement that there is a need for physician-pharmacist collaboration (98.2%), and 94.8% declared that pharmacists can help physicians in patient care and pharmacotherapy. Most pharmacists (80%) believed that physicians were not aware of the competencies of pharmacists resulting from Polish law. Patient education (89.9%), detection of polypharmacy (88%), and detection of interactions between drugs and dietary supplements (85.7%) were the most common tasks in the field of pharmaceutical care that can be provided by a pharmacist. Females were more likely (p < 0.05) to declare the need for physician-pharmacist collaboration. Age and location of the pharmacy were the most important factors (p < 0.05) associated with pharmacists' attitudes toward physician-pharmacist collaboration.

Roadmap to engagement: Bringing patient partners into cancer research and beyond

The University of Kansas Cancer Center (KU Cancer Center) initiated an engagement program to leverage the lived experience of individuals and families with cancer. KU Cancer Center faculty, staff, and patient partners built an infrastructure to achieve a patient-designed, patient-led, and research-informed engagement program called Patient and Investigator Voices Organizing Together (PIVOT). This special communication offers an engagement roadmap that can be replicated, scaled, and adopted at other cancer centers and academic health systems. PIVOT demonstrates that collaboration among academic leaders, investigators, and people with a lived experience yields a patient-centered, vibrant environment that enriches the research enterprise.

The effects of educational intervention on patient participation in pressure injury prevention: a pilot study

OBJECTIVE

Patients' roles in reducing pressure injuries (PIs) are emphasised in clinical guidelines, although patients' preferences are undetermined. This study evaluated the effects of a pilot six-month educational intervention on patient participation in PI prevention.

METHOD

A convenience sampling method was used to select patients admitted to medical-surgical wards at one of the teaching hospitals in Tabriz, Iran. This is a one-group pre-test and post-test interventional study, conducted via quasi-experimental design. Using a pamphlet, patients received education in preventing PIs. Data collected before and after intervention through a questionnaire were analysed using descriptive and inferential statistics (McNemar and paired t-tests) in SPSS software (IBM Corp., US).

RESULTS

The study cohort consisted of 153 patients. Findings revealed that the knowledge of the patients about PIs, patients' ability to talk with the nurses, information received about PIs, and patients' ability to participate in decisions related to PI prevention had significantly increased following the intervention (p<0.001).

CONCLUSION

Educating patients can improve their knowledge to enable them to participate in PI prevention. The findings of this study suggests further research is necessary on factors influencing patients' participation in such self-care behaviours.

Medication Decision-Making and the Medicines' Pathway in Nursing Homes: Experiences and Expectations of Involvement of Residents and Informal Caregivers

BACKGROUND

Information on how residents and their informal caregivers are involved in the medicines' pathway in nursing homes is scarce. Likewise, it is not known how they would prefer to be involved therein.

METHODS

A generic qualitative study using semi-structured interviews with 17 residents and 10 informal caregivers from four nursing homes was performed. Interview transcripts were analyzed using an inductive thematic framework.

RESULTS

Four themes were derived to describe resident and informal caregiver involvement in the medicines' pathway. First, residents and informal caregivers show behaviors of involvement across the medicines' pathway. Second, their attitude towards involvement was mainly one of resignation, but variation was noted in their involvement preferences, ranging from minimal information to active participation needs. Third, institutional and personal factors were found to contribute to the resigned attitude. Last, situations were identified that drive residents and informal caregivers to act, regardless of their resigned attitude.

CONCLUSIONS

Resident and informal caregiver involvement in the medicines' pathway is limited. Nevertheless, interviews show that information and participation needs are present and show potential for residents' and informal caregivers' contribution to the medicines' pathway. Future research should explore initiatives to increase the understanding and acknowledgement of opportunities for involvement and to empower residents and informal caregivers to take on their roles.

Short Report: Where do caregivers of persons with intellectual or developmental disabilities obtain information about medication?

BACKGROUND/AIMS/METHODS

Medication information is available from many sources. This short report provides a simple description of where caregivers of people with intellectual/developmental disability (IDD) obtain medication information, and compares these sources between family caregivers and direct support professionals (DSP).

PROCEDURES/OUTCOMES

Cross-sectional study design using an internet-based survey of caregivers, aged 18 years or older, who provided support to adults with IDD. The primary outcome is the source of medication information reported by caregivers.

RESULTS/CONCLUSIONS

Eighty-nine caregivers responded. Health care professionals were the primary source (87.6 %) of medication information, followed by the internet (77.5 %). There was no difference between caregiver groups for these two sources. The prescription label/information sheet was the next most common source (56.2 %), with significantly more family (76.2 %) versus DSP (38.3 %), p < 0.001. A medication reference was also common (43.8 %), with 28.6 % of family and 57.4 % of DSP, p = 0.006. House manager/nurse was next, with 16.9 %, and television/radio as a source (10.1 %), no difference between groups. Lastly, friends or coworkers were 7.9 %, with no DSP endorsing this option, p = 0.006.

IMPLICATIONS

Caregivers obtain medication information from a variety of sources, with health care professionals being the primary source. The internet was also very common, which may be worrisome, due to the wide range of level of quality of information available. Educational interventions should be developed to provide caregivers with tools to be able identify and use legitimate medication information.

Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives

The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.

Patient participation during discharge medication counselling: Observing real-life communication between healthcare professionals and patients

OBJECTIVES

Previous studies on hospital discharge showed limited patient involvement, despite its positive outcomes. In this study, provider-patient communication used to enhance patient participation during discharge medication counselling was examined.

METHODS

This study comprises a qualitative descriptive observational study. Thirty-four discharge consultations were observed, audio recorded and analysed. We conducted a deductive analysis, elaborating on findings from earlier research. We selected themes and underlying codes illustrating professional-patient communication. For every theme, we identified examples to demonstrate its manifestation during discharge medication counselling. We also assessed what information healthcare professionals (HCPs) shared.

RESULTS

HCPs used cues to increase patient participation, e.g. inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. Patient participation occurred through asking questions, and expressing concerns. A central component in discharge medication counselling was the transmission of information from HCPs to patients. This resulted in HCPs taking a leading role.

CONCLUSIONS

Several HCP cues were detected inviting patients to participate in consultations. Some patients participated in discharge medication counselling. This was influenced by timing of discharge consults, the performing HCP and presence of a relative.

PRACTICE IMPLICATIONS

HCPs shared a lot of information with patients. However, this does not automatically mean that patients will be able to understand and apply this information. HCPs should understand the importance of using cues to enable patient participation. One example is using the teach-back method for verifying patient understanding. It may also be desirable to ensure that a relative is present when discharge information is offered.

Knowledge, attitude, behaviour, and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases: a cross-sectional study

BACKGROUND

Older adults with chronic diseases require long-term medication. However, due to lack of drug knowledge and hypomnesia, older adults with chronic diseases are prone to adverse drug events and increased medical costs. This study aimed to explore the status and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases in China to provide a basis for follow-up to conduct targeted health education.

METHODS

Overall, 427 community-dwelling older adults with chronic diseases participated in this study. The Knowledge, Attitude, and Behaviour of Medication Safety among Older Adults with Chronic Diseases Questionnaire was used to assess their home-based medication safety. Multivariate linear regression was used to identify the factors influencing knowledge, attitude, and behaviour regarding medication safety.

RESULTS

The average score of home-based medication safety among older adults with chronic diseases was 68.26 ± 8.96, indicating that they had a moderate grasp of medication safety. The scoring rate of each subscale was ranked from high to low as follows: behaviour (84.51%), knowledge (63.33%), and attitude (47.39%). Stepwise linear regression analysis showed that medication safety knowledge, attitudes, and behaviours were significantly associated with higher monthly income, adverse drug events, and taking medicine several times a day (p < 0.05). Additional influencing factors included having fewer chronic diseases, being female, higher educational attainment, taking medicines multiple kinds a day, better self-care ability, and non-hospitalisation for chronic illnesses (p < 0.05).

CONCLUSION

Medical staff and community workers should pay attention to the drug safety of older adults with different characteristics and mobilise their enthusiasm for participation to improve their medication self-management ability.

TRIAL REGISTRATION

Chinese Clinical Trial Register: ChiCTR2200060987 ; reg. date: 15/06/2022.

How to engage patients in achieving patient safety: A qualitative study from healthcare professionals' perspective

All parties involved in health care, including patients and their families/caregivers play a significant role to achieve patient safety. Furthermore, patient engagement (PE) has not been adequately implemented to achieve safe healthcare in Indonesia, despite the introduction of the patient-centered care paradigm. This study aims to explore healthcare professionals' (HCPs) perspectives on PE and its application technique. A qualitative study was conducted in the chronic wards of a faith-based private hospital in Yogyakarta Province, Indonesia. Four focus group discussions among 46 HCPs, followed by 16 in-depth interviews, were carried out. Furthermore, the verbatim transcripts were subjected to thematic analysis. The result showed four main themes, including PE as a strategy for achieving safe healthcare, factors affecting its implementation, the need for comprehensive strategies to engage the patients, and their roles in safety efforts. Furthermore, the implementation of PE can be enhanced by encouraging healthcare professionals (HCPs) to play proactive roles in empowering recipients. To achieve PE, "partnership culture" and the removal of potential barriers as well as determining factors, must be established. This requires a high-level commitment, organizational support with a top-down approach, and integration into healthcare systems. In conclusion, PE is essential for patient safety and can be enhanced by strengthening organization support, integrating into the healthcare system, improving HCPs' roles, and empowering patients and caregivers to overcome potential barriers.

Engaging patients in patient safety: a qualitative study examining healthcare managers and providers' perspectives

BACKGROUND

Patients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers' (HCPs) and managers' perceptions on patient participation in patient safety processes.

METHODS

This qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis.

RESULTS

Three main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care.

CONCLUSION

The participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting.

Using consumer engagement strategies to improve healthcare safety for young people: An exploration of the relevance and suitability of current approaches

BACKGROUND

Consumer engagement in health care is recognized as a critical strategy to minimize healthcare-associated harms, however, little research has focussed on strategies to engage young people in healthcare safety. This study explores the suitability of commonly used engagement strategies, such as brochures, interactive bedside charts or apps, for young people (14-25 years) to improve their healthcare safety, with a focus on cancer care.

METHODS

Four qualitative online workshops were conducted (N = 19). Two workshops included young people who had experienced cancer (n = 6) and two workshops included staff who support young people who had experienced a diagnosis of cancer (n = 12). Evidence from a systematic review was used to develop case studies of existing strategies as a topic guide for the online workshops. Data were analysed using a framework method and template analysis approach.

RESULTS

Thematic analysis against the analytic framework led to the development of four principles for engagement with young people: empowerment, transparency, participatory culture and flexibility. The transition from being 'looked after' to young people being responsible for their own care was an integrative theme which intersected all elements of the framework.

CONCLUSION

For service providers to engage with young people about safety issues in cancer services, the strategies employed need to be tailored to consider the transitional nature of being an adolescent or young adult. A systemic approach that incorporates flexible, tailored engagement strategies, education and empowerment of young people and healthcare providers is required to engage effectively with young people about safety in healthcare. These findings may have implications beyond cancer care.

PATIENT OR PUBLIC CONTRIBUTION

Workshop content was developed with and by the CanEngage team, including the Consumer Advisory Group, who reviewed content and inform wider project priorities.

Barriers adult refugees face to community health and patient engagement: a systematic review

Meeting the health needs of refugee populations and increasing access to healthcare remains a challenge for healthcare systems globally. As such, community health and patient engagement are increasingly recommended strategies to address health-related issues among refugees. This systematic review aims to identify the reported barriers that adult refugees encounter with community health and patient engagement. Data sources included MEDLINE, Embase, APA PsycINFO, CINAHL, and Core Collection (Web of Science), yielding 1156 records. After removing duplicates and two levels of screening, 18 studies were selected for qualitative analysis. The barriers were conceptualised as cultural norms, pre-departure history, education, language proficiency, stigma, racism, social support, and multi-factorial barriers. These barriers can be addressed to improve rapport with refugees and the quality of community health and patient engagement initiatives.

Effectiveness of Mobile Medical Apps in Ensuring Medication Safety Among Patients With Chronic Diseases: Systematic Review and Meta-analysis

BACKGROUND

Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety.

OBJECTIVE

Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients' medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis.

METHODS

The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases-PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants' characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis.

RESULTS

We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app's features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58).

CONCLUSIONS

We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072.

Mobile medical applications’ state quo and underlying barriers: review of literature†

Objective

To explore the current development and challenges regarding mobile medical applications (mmAPPs), so as to provide reference for application function elevation and quality improvement.

Methods

We retrieved literature databases like Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, China Biomedical Network, time limit was from January 1, 2010 to December 31, 2021, and restricted to the Chinese or English language.

Results

This study concluded with the following six aspects: Domestic and foreign development of mmAPP, reminder function, barriers and challenges (low quality; slow update rate; lack of standard evaluation tool or criterion), privacy and safety concerns, adverse drug event report state (low report rate-related reasons, different countries’ report policies), and current hindrances in the progression (economic worries; personal education level; acceptance and study of technology; rural districts, and low-income countries).

Conclusions

We should focus on the application's quality elevation rather than quantity, pay more attention to patients’ adverse drug event reports, privacy and safety, and place emphasis on rural districts and low-income countries.

Interventions to reduce the incidence of medical error and its financial burden in health care systems: A systematic review of systematic reviews

Background and aim

Improving health care quality and ensuring patient safety is impossible without addressing medical errors that adversely affect patient outcomes. Therefore, it is essential to correctly estimate the incidence rates and implement the most appropriate solutions to control and reduce medical errors. We identified such interventions.

Methods

We conducted a systematic review of systematic reviews by searching four databases (PubMed, Scopus, Ovid Medline, and Embase) until January 2021 to elicit interventions that have the potential to decrease medical errors. Two reviewers independently conducted data extraction and analyses.

Results

Seventysix systematic review papers were included in the study. We identified eight types of interventions based on medical error type classification: overall medical error, medication error, diagnostic error, patients fall, healthcare-associated infections, transfusion and testing errors, surgical error, and patient suicide. Most studies focused on medication error (66%) and were conducted in hospital settings (74%).

Conclusions

Despite a plethora of suggested interventions, patient safety has not significantly improved. Therefore, policymakers need to focus more on the implementation considerations of selected interventions.

“Nothing for Us Without Us”: An Evaluation of Patient Engagement in an HIV Care Improvement Collaborative in the Caribbean

This evaluation suggests that it is both possible and valuable to include patients as partners in quality improvement efforts, especially when resources must be prioritized for the highest impact efforts. Patient engagement in the improvement process is particularly powerful when addressing illnesses that may be stigmatized such as HIV.

Introduction:

Patient engagement is increasingly recognized as a key strategy to promote patient-centered care and accelerate health care improvements. Ensuring patient participation in improvement efforts is particularly important with stigmatized illnesses and marginalized populations. Despite the attention it has garnered, patient engagement is still not widely implemented and has not been well documented in global health literature.

Methods:

We implemented a patient-engagement strategy to involve people living with HIV in quality improvement efforts. As part of the Caribbean Regional Quality Improvement Collaborative, quality improvement teams from Barbados (1 team), Jamaica (20 teams), Suriname (3 teams), and Trinidad and Tobago (2 teams) engaged health care providers from care facilities and people living with HIV to serve as community representatives (CRs) to lead the improvement efforts alongside them. This strategy was evaluated via a mixed method design that included 2 rounds of semistructured, in-depth interviews with patients and providers.

Results:

Findings suggest that the patient engagement strategy had several key strengths: it promoted the collection, use, and appreciation of patient input to inform health care improvements at the facility level; facilitated the empowerment of CRs; enhanced mutual understanding and empathy between CRs and providers; and helped to dispel HIV stigma and discrimination in health care settings. Moreover, both health care providers and CRs reported that CR opinions and perspectives are as important as providers' and that CR participation in the improvement process was beneficial.

Assessment of medication adherence, medication safety awareness and medication practice among patients with lung cancer: A multicentre cross-sectional study

OBJECTIVES

We aimed to explore the current status of medication adherence, safety awareness and practice among patients with lung cancer.

METHODS

We conducted a questionnaire-guided cross-sectional study in Xi'an, Yulin, Hanzhong and Weinan in Shaanxi Province, China, from April to June 2021 for a period of 3 months. The study questionnaire was developed according to previous related studies reported in the literature, and includes basic demographic information and patients' medication safety questions. The data were double-entered using EpiData 3.1 software; descriptive statistics, t-test, analysis of variance, the Kruskal-Wallis test and the Mann-Whitney U-test were performed to analyse the data.

RESULTS

A total of 567 participants were included, and 409 valid questionnaires were finally completed, with an effective response rate of 72.13%. More than 80% of patients showed good medication adherence; the average adherence score was 22 ± 2.68 of 25. The average score for medication safety awareness was 16.40 ± 4.41, which was significantly lower than that of medication adherence (p < .001). Only 22.74% of patients always checked their medicines before a nurse administered them; 17.60% of patients never checked their medicines. Few patients actively consulted an health care professional to understand safety information before taking a medication. A significant difference existed in safety awareness scores among age groups (p = .039) and geographic regions (p < .001). Patients with three or more comorbidities had the lowest awareness scores (p = .027).

CONCLUSION

We found that patients with lung cancer showed better medication adherence, but their awareness about medication safety was poor. Older patients, those with comorbidities and patients in regions with poor medical resources may have worse awareness about safety. Current medication education for patients should not only aim to improve adherence but should also encourage patients to take greater responsibility for their own safety and to actively participate in their medication safety. Greater systematic and individualized medication safety information is needed for older patients, those with more comorbidities and patients in areas with poor medical resources.

PATIENT CONTRIBUTION

We conducted a questionnaire-guided cross-sectional study on hospitalized lung cancer patients in Shaanxi Province to explore the patients' practices related to safety medication, including medication adherence and medication safety awareness.

Desenvolvimento participativo de tecnologia educacional em busca da segurança do paciente na maternidade

RESUMO Objetivos: desenvolver uma cartilha como tecnologia educacional, juntamente com profissionais de saúde, pacientes e acompanhantes, visando ao envolvimento destes na segurança do paciente na maternidade. Métodos: estudo qualitativo convergente-assistencial, realizado em três etapas em uma maternidade de Belo Horizonte. A construção da cartilha ocorreu entre fevereiro e abril de 2021, com 13 profissionais, 06 acompanhantes e 11 pacientes. Resultados: realizou-se análise de conteúdo dos dados, criando-se três categorias: Saberes e experiências sobre a segurança da paciente e do recém-nascido na maternidade; Desafios para o envolvimento da paciente e acompanhante nas ações de segurança; Avaliação das pacientes, acompanhantes e profissionais sobre o processo de construção da cartilha. A construção da cartilha envolveu a participação profissionais de saúde, usuários e acompanhantes em todas as etapas do processo. Considerações finais: o processo participativo possibilitou a criação da tecnologia educacional para o envolvimento das pacientes e acompanhantes nas ações de segurança do paciente.

[Medication management in home care-The medication use process from the perspective of clients and their caregivers]

BACKGROUND

Professional home care nurses are often tasked with the medication management of older, polymedicated clients. The medication use process is often complex and prone to medication errors. From the perspective of professional caregivers, the interprofessional interfaces of care as well as the integration of clients and informal caregivers are a major challenge.

AIM

With this study, we explored the perspective of home care clients and their informal caregivers on the medication use process supported by professional caregivers with a focus on medication safety.

METHOD

We chose a qualitative research approach, using guideline-based interviews with eight clients and five caregivers. Data were analyzed applying the topical analysis according to Braun and Clarke.

RESULTS AND DISCUSSION

Before engaging professional home care nurses in the medication use process, clients reached their physical, psychological and social limits. They were relieved when the professional home care organization took care of the overall coordination of the medication use process and felt safe. They trust professional caregivers and see limited need to be preoccupied with medication safety themselves, despite risks inherent in self-medication, adherence and transition of care.

CONCLUSION

Through the relief provided by professional caregivers, home care clients and their informal caregivers no longer perceive themselves as active partners in maintaining medication safety. Healthcare professionals should keep an eye on self-medication as well as adherence and support the use of the medication plan.

Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis

OBJECTIVES

The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture.

METHODS

This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture.

RESULTS

The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health.

CONCLUSIONS

Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.

Medication error awareness among health care providers in Palestine: a questionnaire based cross-sectional observational study

Background

Increased awareness among healthcare professionals regarding medication errors and the establishment of a medication error reporting system can significantly reduce the prevalence of medication errors. Unfortunately, Palestine lacks a regulatory system for the control, reporting, and education of medication errors.

Objectives

This study aimed to assess the awareness of medication errors and reporting of medication errors in the Palestinian medical community.

Methods

A cross-sectional observational study was conducted using a self-administered survey involving doctors, nurses, and pharmacists in Palestine. The survey consisted of 20 questions to assess healthcare providers' awareness and course of actions related to medication errors. Data were collected from February 2020 to April 2020. Statistical Package for the Social Sciences (SPSS) was used for data analysis. This study was approved by the ethical committee of Birzeit University.

Results

A total of 394 participants were included, including 202 nurses, 114 doctors, and 78 pharmacists. 203 (51.5%) had a good awareness level of medication errors, whereas 126 (32%) and 65 (16.5%) had average awareness and poor awareness levels, respectively. In addition, 66.0% of providers did not inform the patients after recognizing the error. Fear of legal or social consequences and being too busy are significant barriers to reporting medication errors. Moreover, 35 % of all providers were not aware of the reporting system in their institutions or the reporting methodology, and only 26% of all participants confirmed that their institutions provided continuous education on medication errors.

Conclusion

This study revealed differences in healthcare professionals' awareness of medication errors. The study's findings emphasize the urgent need to adopt appropriate measures to raise awareness about medication errors among healthcare providers in Palestine. Furthermore, establishing a regulatory policy and a national medication error reporting system to improve medication safety.

Relational dynamics involved in therapeutic discordance among prescribers and patients: A Grounded Theory study

OBJECTIVE

No studies have explored the negative process of concordance: discordance in prescribing-medication-taking. This study provides a deeper understanding of discordance as a co-constructed process among patients and prescribers.

METHODS

To explore the question "what psychological and relational processes are involved when therapeutic discordance among prescribers and receivers occurs?" a constructivist Grounded Theory study was carried out through semi-structured interviews with patients and their medical doctors.

RESULTS

The final sample of our study was composed of 29 participants: 16 receivers and 13 prescribers. "Neglecting the relationship", the core category, shapes the therapeutic discordance and connects three main conceptual phases: signing a non-negotiating contract, acting alone, and establishing a superficial relationship.

CONCLUSION

Our grounded theory conceptualization contributes to the concordance-related debate by evidencing the processes among prescribers and receivers in interwoven actions. It offers another dimension to how notions of compliance, adherence and concordance have been theorized to date.

PRACTICE IMPLICATIONS

More than one interaction with receivers is recommended. If there are hints that conflict potentially is compromising the relationship, prescribers should involve intermediaries. Setting aside for a moment, evidence-based justification for treatments and trying to understand prescribers' motivations may boost a positive change.

Participatory development of educational technology in seeking patient safety in maternity hospitals

ABSTRACT Objectives: to develop a booklet as an educational technology, together with health professionals, patients and companions, aiming at their involvement in patient safety in maternity hospitals. Methods: a qualitative convergent care study, carried out in three stages at a maternity hospital in Belo Horizonte. The booklet construction took place between February and April 2021, with 13 professionals, 06 companions and 11 patients. Results: data content analysis was performed, creating three categories: Knowledge and experiences about patient and newborn safety in maternity hospitals; Challenges for involving patient and companion in safety actions; Assessment of patients, companions and professionals on the booklet construction process. The booklet construction involved the participation of health professionals, users and companions in all stages of the process. Final considerations: the participatory process enabled the creation of educational technology for the involvement of patients and companions in patient safety actions.

Older patients' engagement in hospital medication safety behaviours

BACKGROUND

Increasing age is associated with more medication errors in hospitalised patients. Patient engagement is a strategy to reduce medication harm.

AIMS

To measure older patients' preferences for and reported medication safety behaviours, identify the relationship between preferred and reported medication safety behaviours and identify whether perceptions of medication safety behaviours differ between groups of young-old, middle-old and old-old patients (65-74 years, 75-84 years, and ≥ 85 years).

METHODS

A survey, which included the Inpatient Medication Safety Involvement Scale (IMSIS) was administered to 200 older patients from medical settings, at one hospital. Data were analysed using descriptive statistics, Spearman's rho and the Kruskal-Wallis test.

RESULTS

Patients reported a desire to ask questions (59.5% n = 119) and check with healthcare professionals if they perceived that a medication was wrong (86.5% n = 173) or forgotten (87.0% n = 174). Patients did not have particular preferences, which differed from their experiences in terms of viewing the medication administration chart and self-administering medications. Preferred and reported behaviours correlated positively (r = 0.46-0.58, n = 200, p ≤ 0.001). Young-old patients preferred notifying healthcare professionals of perceived medication errors more than middle-old and old-old patients (p ≤ 0.05).

CONCLUSIONS

Older patients may prefer verbal medication safety behaviours like asking questions and notifying healthcare professionals of medication errors, over viewing medication charts and self-administering medications. The young-old group wanted to identify perceived medication errors more than other age groups. Older patients are willing to engage in medication safety behaviours, and healthcare professionals and organisations need to embrace this engagement in an effort to reduce medication harm.

Applying the Social-Ecological Approach to Evaluate Diabetes Medication Management in Older People

Glucagonlike peptide-1 receptor agonist is a common antidiabetic medication class to lower HbA1c, weight, and cardiovascular risk. This case study describes the challenges a patient with uncontrolled diabetes faced after receiving a prescription for liraglutide because of multiple levels of influence, including individual, family, institutional, and policy level barriers. The case highlights the importance of utilizing a person-centered care approach by evaluating patient's preferences, visual and motor coordination, cognitive function, psychological stress, and medication cost before prescribing injectable products for elderly patients.

Older patient and family discharge medication communication: A mixed-methods study

RATIONALE, AIMS, AND OBJECTIVES

Medication discrepancies place patients discharged from hospital at risk of adverse medication events. Patient and family participation in medication communication may improve medication safety. This study aimed to examine older medical patient and family participation in discharge medication communication.

METHODS

Two-phased mixed-methods study. Data were collected from July 2018 to May 2019. Phase 1 comprised observations and a questionnaire of 30 patients pre-hospital discharge. Phase 2 involved telephone interviews with 11 patients and family members post-hospital discharge. Phase 1 analysis included descriptive statistics and deductive content analysis. Inductive content analysis was used in Phase 2. Phase 1 and 2 findings were integrated.

RESULTS

For Phase 1, observational data were deductively coded against the "continuum of patient participation"; information-giving was the most frequent level of participation observed on the continuum, followed by information-seeking, shared decision making, non-involved, and finally autonomous decision making. For descriptive statistics, written communication tools, noise, and interruptions were frequently observed during medication communication. In Phase 2, three categories were found about how patients and families participate, and the factors influencing their participation: (a) obtaining comprehensive medication information; (b) preferred approaches for receiving information; and (c) speaking about medications in hospital. Integrated findings showed that written communication tools and routine hospital tasks may promote, while lack of family presence and environmental factors may hinder medication communication. Patients' and families' role in medication communication ranged from asking questions to influencing decisions, and was enhanced by health care professionals' patient-centred communication.

CONCLUSIONS

More active patient and family participation could be achieved by encouraging them to identify medication-related problems. To create a climate for patient and family participation, health care professionals should use written communication tools, capitalize on participation opportunities during routine hospital tasks, and use patient-centred communication.

The impact of patient and public involvement in health research versus healthcare: A scoping review of reviews

Many policies promote patient and public involvement (PPI) in health research and healthcare provision. However, research points to uncertainties about its impact. The aim of the article was to compare what types of impact have been reported in reviews of PPI in health research and healthcare, respectively, and to map differences and similarities between the review studies. A review of reviews was undertaken with a search strategy based on the PCC mnemonic for scoping reviews. Four online databases were searched. Studies published in English between the years 2000-2020, using a review-based method and aiming to demonstrate impact of PPI were included, resulting in sixty-one articles. More reviews of PPI impact in healthcare than in health research were found, although the latter included a larger number of empirical studies. Systematic reviews, quality assessment and quantitative studies were less common in health research. Many original studies were from the United Kingdom. In health research, reported impacts most often related to research design and delivery, while in healthcare the most commonly reported impacts were individual health outcomes/clinical outcomes. However, there is still uncertainty about the strength of evidence for PPI, in particular when it comes to collective involvement in healthcare, that is in policymaking and service improvement initiatives at hospitals or the like.

Feasibility of a patient engagement and medication safety management program for older adults suffering cardiovascular disease in community settings

OBJECTIVES

To assess the feasibility of a patient engagement and medication safety management (PE-MSM) program on medication errors, self-efficacy for appropriate medication and activation among older patients suffering cardiovascular disease (CVD) in Chinese communities.

METHODS

A patient engagement and medication safety management (PE-MSM) program intervention study was performed. Older patients suffering CVD in the intervention group (n = 62) received PE-MSM program, while the control group (n = 58) took a 12-week medication safety education alone.

RESULTS

Compared with the control group, patients having undergone the individualized PE-MSM program achieved lower incidence of medication errors (P < .001), and a statistically significant interaction was identified between treatment groups and assessment time points in terms of the total score of self-efficacy for appropriate medication use scale and the number of patients with different activation levels (P < .001).

CONCLUSIONS

The PE-MSM program is demonstrated to be feasible. Compared with single medication safety education, the PE-MSM program is capable of decreasing the incidence of common medication errors, enhancing the self-efficacy of appropriate medication and the activation of older patients with CVD in a community.

PRACTICE IMPLICATIONS

The PE-MSM program is likely to act as a promising medication management model for the routine health care of older patients suffering CVD in communities.

Building Community-Engaged Multidisciplinary Partnerships to Improve Medication Management in Elderly Patients With Multiple Chronic Conditions

PURPOSE

Many studies in preventing adverse drug events have been researcher-driven, yet few have engaged patients in the development of a project. This project aims to engage minority elderly patients with multiple chronic conditions in the development of research questions and strategies to improve medication safety.

METHODS

Elderly patients (≥65 years old) who were prescribed 7 or more chronic medications were recruited through a university-based aging resource network in a historically African American community in Houston, Texas. Patients and a caregiver participated in a multidisciplinary workgroup comprised of a physician, pharmacists, a nurse, health educators, and a social worker. Patients were engaged by utilizing the 4 patient-centered outcomes research engagement principles. The workgroup created a strategic plan, completed an environmental scan, identified research problems, and reviewed current evidence-based approaches in the literature. Workgroup findings were presented to a broader audience within a community town hall setting, and input was collected from a community-wide survey.

RESULTS

From April 2018 to July 2018, 3 patients and 1 caregiver participated in 5 multidisciplinary workgroup meetings. A total of 74 seniors attended the town hall meeting, and 69 completed the surveys. The most common drug-related problems among survey participants were doubts about drug advertisements (79%) and drug interactions (70%). Most participants (88%) were more comfortable in receiving face-to-face counseling compared to an app or virtual visits. Findings aided in developing 3 grant proposals.

CONCLUSIONS

This narrative provides a roadmap for conducting multidisciplinary, patient-centered participatory research to refine research strategies in minimizing drug-related problems.

Patientensicherheit in der Dermatologie: Optionen zu ihrer Optimierung

Um die Patientensicherheit in der Dermatologie zu verbessern, gilt es, „vermeidbare unerwünschte medizinische Ereignisse“, definiert als „Patienten schadende Vorkommnisse, die eher auf der Behandlung als auf der Erkrankung selbst beruhen und die durch einen Fehler verursacht sind“, zu minimieren. Bereits die Problemwahrnehmung von möglichen Behandlungsfehlern ist dabei ein wichtiger erster Schritt. Diese Bewusstseinsschärfung geschieht wesentlich dadurch, dass alle Aspekte der Patientensicherheit in die ärztliche Aus- und Weiterbildung sowie in Fortbildungen integriert werden. Für die tägliche Praxis von medizinischen Einrichtungen spielt nach den Vorgaben des Gesetzgebers das Qualitätsmanagement eine wesentliche Rolle, in dem die Patientensicherheit als eine Priorität Berücksichtigung findet. Diese Qualitäts- und Sicherheitsorientierung muss als Führungsaufgabe verstanden werden, der auch angesichts konkurrierender, insbesondere ökonomischer, Unternehmensziele Vorrang einzuräumen ist. Mit der obligatorischen Einführung von Patientensicherheitsbeauftragten in Krankenhäusern, wie aktuell in Hessen erfolgt, kann dem Thema im Klinikmanagement eine wichtige Stimme verliehen werden. Neben der zu fördernden Patientenpartizipation am Behandlungsprozess auch bez. der Patientensicherheit ergeben sich gerade auch in der Dermatologie erhebliche Potenziale durch die Digitalisierung des Gesundheitswesens (e-Health). Auch wenn diese eigene Risikopotenziale beinhaltet, könnte sie zur Diagnose-, Therapie- und Koordinations- und Kommunikationssicherheit in der Dermatologie beitragen.

Expert perspectives on the active role of patients in their safety: Toward a framework using Delphi methodology

AIMS

To develop a framework for Patient Engagement in Patient Safety (PEPS) in hospital.

METHODS

The Delphi technique was embraced to involve a group of knowledgeable healthcare experts in the discussion and rating of the components of the PEPS framework. On a 5-point Likert scale, every item was separately rated based on the three aspects, which include applicability, clarity and validity. The PEPS framework included items with 75% or more of participants scoring 4-5 on all three aspects. Items not attaining 75% agreement on the aspects were either changed or discarded, after the group discussion and underwent another round of rerating.

RESULTS

A total of 17 members participated in the consensus-building process. Following two rounds of rating, the consensus was reached on the final framework which consisted of 28 items in four dimensions, relating to healthcare professionals, patients, community, and helth system, and three components substituted with patient empowerment, effective communication and patient-centeredness.

CONCLUSION

The development of PEPS framework is a stimulus to strengthen human resources for health capabilities, sustain a high level of quality patient outcomes, and improve the health system. Further studies to identify strategies are needed for the successful implementation of this framework.

GAMES AS AN EDUCATIONAL TECHNOLOGY FOR THE INVOLVEMENT OF COMPANIONS IN PEDIATRIC PATIENT SAFETY: A QUALITATIVE STUDY

ABSTRACT Objective to describe the meaning attributed to the use of a game as an educational technology for the involvement of companions in pediatric patient safety. Method a qualitative study carried out with 16 companions of children admitted to the Pediatric Unit of the public hospital in Minas Gerais, Brazil. Data collection took place from October to December 2019, through semi-structured interviews, after using the game as an educational technology. Symbolic Interactionism was used as the theoretical framework and Inductive Content Analysis, as the method. Results playing the game in search of patient safety was an important strategy for sharing knowledge and co-responsibility for the companions to engage in the pediatric patient safety actions, in addition to a relevant contribution to the prevention of adverse events. On the other hand, the professionals' overload and communication problems stood out as barriers to the establishment of a bond among the health team members and, consequently, the involvement of the companions in patient safety. Conclusion the companions recognized themselves as partners in the prevention of adverse events and highlighted some behavioral changes in favor of patient safety after participating in the playful intervention. Thus, it is considered that the game can be an important and interactive strategy for disseminating information to companions and family members and, consequently, favoring the increased participation of these actors in patient safety actions.

Assessment of Public Perception Regarding Patient Engagement for Patient Safety in Korea

OBJECTIVES

This study conducted a survey to examine how the general public in Korea perceives patient engagement for patient safety and to identify vulnerable groups and contents priorities of patient engagement education for the general public.

METHODS

We developed a questionnaire based on previous studies and conducted one-on-one interviews with 600 individuals from the public. Then, we conducted descriptive statistical analyses (i.e., frequency, percentage, and averages) on the questionnaire items. Furthermore, we examined the individual differences of participants' sociodemographic characteristics in their responses to the questionnaire.

RESULTS

The general public's awareness regarding accreditation programs for healthcare organizations was still low (47.4%). Nearly 60% of participants said that they did not agree with the practice of telling their own names and dates of birth before treatment. Approximately 80% of the participants would not ask medical staff to confirm washing their hands. Only half of the participants were aware of medical dispute mediation and arbitration programs. Nearly 90% of the participants agreed that patient safety is important. However, on participants' confidence in making the correct choice and safety in their treatment, the average score was 68.7 of 100 points. Participants tended to be less confident about engaging in patient safety activities if they were older, less educated, or had poor health status.

CONCLUSIONS

Participants in this study believed that patient safety is an important issue, but they were not confident about choosing the correct medical institution or about receiving safe treatment.

Interventions to Engage Patients and Families in Patient Safety: A Systematic Review

The involvement of patients and families is essential for improving patient safety. However, the role of patients and caregivers in patient safety has recently been receiving attention, and programs and interventions have been implemented for patients and caregivers. The objective of this systematic review was to identify the types of interventions to improve patient safety that focused on engaging patients and their families, and the effectiveness of these interventions. Searching four electronic databases, 2019 articles were obtained; of these, 15 articles met the inclusion criteria. The studies used intervention strategies at the "information" and "involvement" engagement levels. Interventions with strategies only at the information level mostly measured safety perception and were mostly found to be effective. Interventions with both information and involvement strategies measured more diverse outcomes, but their effectiveness was inconsistent. Further studies using a range of intervention strategies and outcomes with more rigorous methodologies are needed.PROSPERO registration number CRD42018096162.

Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study

OBJECTIVES

To evaluate patients' views on the content and use of the 'Five Moments for Medication Safety' materials developed as part of the WHO's 'Medication Without Harm' Global Patient Safety Challenge. These comprise a booklet, flyer, infographic poster, pamphlet and mobile application. They include recommended questions for patients to ask healthcare professionals to gain a better understanding of their medication.

METHODS

Structured interviews were conducted with members of the public who entered an outpatient pharmacy in a London teaching hospital, using a combination of open and closed questions. Qualitative data were analysed thematically. Quantitative data were analysed descriptively. χ², Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests were used to test for associations between responses and variables such as age.

RESULTS

We approached 147 people; 100 (68%) agreed to take part. Of these, 83% thought that the materials would be 'quite' or 'very' useful. Potential barriers to their use were patients being of the view that they already ask healthcare professionals about their medicines or that there would be limited time available to answer their questions during consultations. Fifty-nine per cent of participants stated that they would prefer to be given the materials in waiting areas before seeing a healthcare professional; 61% thought they should be displayed on television screens in general practice surgeries. Age was significantly associated with preference for the mobile application (χ² test, p<0.01), with younger people preferring this format.

CONCLUSIONS

Patients' views of the Five Moments for Medication Safety materials were generally positive. Our findings suggest that they should be displayed on television screens in waiting areas and given to patients prior to appointments. More advice is needed for patients on how to incorporate the questions suggested in the resources into a brief healthcare consultation.

PRN Medicines Optimization and Nurse Education

Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. ''Pro re nata'' (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses' roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice.

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review

Background

Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes).

Methods

Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed.

Results

Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months).

Conclusions

Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.

Adoption and Performance of Complementary Clinical Information Technologies: Analysis of a Survey of General Practitioners

Background

The benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation.

Objective

This study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration.

Methods

We used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years.

Results

We unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years.

Conclusions

Different CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain.