Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis

被引:94
作者
Renaudin, Pierre [1 ,2 ]
Boyer, Laurent [2 ]
Esteve, Marie-Anne [1 ,3 ]
Bertault-Peres, Pierre [1 ]
Auquier, Pascal [2 ]
Honore, Stephane [1 ,3 ]
机构
[1] Hop La Timone, Assistance Publ Hop Marseille, Serv Pharm, 264 Rue St Pierre, F-13000 Marseille, France
[2] Aix Marseille Univ, Fac Med Timone, EA Sante Publ Malad Chron & Qual Vie 3279, F-13000 Marseille, France
[3] Aix Marseille Univ, Fac Pharm Timone, Serv Pharm Clin, F-13000 Marseille, France
关键词
clinical pharmacy; medication reconciliation; medication review; meta-analysis; pharmacists; systematic review; ELDERLY-PATIENTS; HEALTH SURVEY; OLDER-PEOPLE; INTERVENTION; CARE; IMPACT; ADMISSIONS;
D O I
10.1111/bcp.13085
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
AimsThe aim of this meta-analysis is to examine the impact of in-hospital pharmacist-led medication reviews in paediatric and adult patients. MethodsRelevant studies were identified from the Medline and Cochrane Library databases. Studies were included if they met the following criteria (without any language or date restrictions): design: randomized controlled trial; intervention: in-hospital pharmacist-led medication review (experimental group) vs. usual care (control group); participants: paediatric or adult population. The primary outcome was all-cause readmissions and/or emergency department (ED) visits at different time points. The secondary outcomes were all-cause readmissions, all-cause ED visits, drug-related readmissions, mortality, length of hospital stay, adherence and quality of life. We calculated the relative risk (RR) or mean differences (MD) with 95% confidence intervals (CIs) for each study. We used fixed and/or random effects models. Heterogeneity was assessed using the I-2 statistic. ResultsWe systematically reviewed 19 randomized controlled trials (4805 participants). The readmission rates did not differ between the experimental group and the control group (RR=0.97, 95% CI 0.89; 1.05, p=0.470). The secondary outcomes did not differ between the two groups, except for in drug-related readmissions, which were lower in the experimental group (RR=0.25, 95% CI 0.14; 0.45, p<0.001), and all-cause ED visits (RR=0.70, 95% CI 0.59; 0.85 p=0.001). ConclusionThe low-quality evidence in this analysis suggests an impact of pharmacist-led medication reviews on drug-related readmissions and all-cause ED visits. Few studies reported on adherence and quality of life. More high-quality randomized clinical trials are needed to assess the impact of pharmacist-led medication reviews on patient-relevant outcomes, including adherence and quality of life.
引用
收藏
页码:1660 / 1673
页数:14
相关论文
共 44 条
[1]  
[Anonymous], MINN LIV HEART FAIL
[2]  
[Anonymous], 2011, ENQUETE NATL EVENEME
[3]  
[Anonymous], SCAND J TRAUMA RE S1
[4]  
[Anonymous], CDC HRQOL 14 HLTH DA
[5]  
[Anonymous], 2014, MOL PSYCHIATR, DOI DOI 10.1038/mp.2013.31
[6]   Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial [J].
Bladh, Lina ;
Ottosson, Ellinor ;
Karlsson, John ;
Klintberg, Lars ;
Wallerstedt, Susanna M. .
BMJ QUALITY & SAFETY, 2011, 20 (09) :738-746
[7]   Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland [J].
Bolas, H ;
Brookes, K ;
Scott, M ;
McElnay, J .
PHARMACY WORLD & SCIENCE, 2004, 26 (02) :114-120
[8]   A basic introduction to fixed-effect and random-effects models for meta-analysis [J].
Borenstein, Michael ;
Hedges, Larry V. ;
Higgins, Julian P. T. ;
Rothstein, Hannah R. .
RESEARCH SYNTHESIS METHODS, 2010, 1 (02) :97-111
[9]   Level of evidence and therapeutic evaluation: need for more thoughts [J].
Bossard, N ;
Boissel, FH ;
Boissel, JP .
FUNDAMENTAL & CLINICAL PHARMACOLOGY, 2004, 18 (03) :365-372
[10]   Medication review in hospitalised patients to reduce morbidity and mortality [J].
Christensen, Mikkel ;
Lundh, Andreas .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (02)