Digital patient safety interventions in primary care: a systematic review and meta-analysis

Patient safety events are among the top ten causes of death and disability worldwide, with most considered preventable, particularly in primary care. Digital interventions are increasingly used in primary care to improve patient safety, targeting errors and preventing adverse events. Evaluating their effectiveness and implementation is essential to inform clinical practice and policy. The study aims included a systematic review and meta-analysis of the effectiveness of digital patient safety interventions in primary care, comparing single and multicomponent interventions, identifying effective components, and exploring factors influencing their success.

MEDLINE, EMBASE, and CENTRAL were searched from January 2001 to June 2025, restricted to English-language publications. This review followed PRISMA guidelines. Randomized controlled trials assessing digital interventions aimed at improving patient safety outcomes in primary care were included. Safety outcomes were grouped into medication safety and non-medication process measures, and adverse events. Two reviewers independently extracted and verified data and assessed risk of bias, resolving discrepancies by consensus. Random-effects meta-analysis was performed for predefined safety outcomes, and a narrative synthesis described implementation factors.

Seventy-four randomized controlled trials (RCTs) were included. Meta-analysis demonstrated benefits for medication safety process measures (k = 54; Odds Ratio (OR) 1.46, 95% confidence interval (CI): 1.30-1.64), non-medication process measures (k = 40; OR 1.77, 95% CI: 1.56-2.01), and adverse events (k = 12; OR 1.17, 95% CI: 1.06-1.30). Overall, multicomponent interventions consistently showed greater improvements than single-component interventions. Interventions combining components of clinical decision support and audit and feedback were most effective for medication safety, while patient-facing components had greater impact on non-medication process measures. Results remained consistent in sensitivity analyses restricted to higher-quality RCTs. Effectiveness was likely influenced by implementation factors, including workflow integration and relational support.

Digital interventions in primary care are associated with moderate improvements across multiple patient safety process measures. Multicomponent approaches appear most promising, with effectiveness potentially shaped by implementation, patient engagement and contextual factors. These findings support the broader adoption of well-designed, contextually adapted digital strategies to enhance patient safety and underscore the need for ongoing evaluation of the sociotechnical factors supporting delivery of these interventions.