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  • Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis

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Systematic review
Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis
  1. Sara Daliri1,
  2. Samira Boujarfi1,
  3. Asma el Mokaddam1,
  4. Wilma J M Scholte op Reimer2,3,
  5. Gerben ter Riet2,3,
  6. Chantal den Haan4,
  7. Bianca M Buurman5,
  8. Fatma Karapinar-Çarkit1
  1. 1 Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
  2. 2 Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands
  3. 3 ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, North-Holland, The Netherlands
  4. 4 Department of Research and Education, Medical Library, OLVG, Amsterdam, North-Holland, The Netherlands
  5. 5 Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands
  1. Correspondence to Dr Fatma Karapinar-Çarkit; f.karapinar{at}olvg.nl

Abstract

Background Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related interventions and show conflicting results. However, until now, no review has focused on the effect of intervention components delivered both in hospital and following discharge from hospital to home.

Objective To examine effects of medication-related interventions on hospital readmissions, medication-related problems (MRPs), medication adherence and mortality.

Methods For this systematic review and meta-analysis, we searched the PubMed, Embase, CINAHL and CENTRAL databases without language restrictions. Citations of included articles were checked through Web of Science and Scopus from inception to 20 June 2019. We included prospective studies that examined effects of medication-related interventions delivered both in hospital and following discharge from hospital to home compared with usual care. Three authors independently extracted data and assessed study quality in pairs.

Results Fourteen original studies were included, comprising 8182 patients. Interventions consisted mainly of patient education and medication reconciliation in the hospital, and patient education following discharge. Nine studies were included in the meta-analysis; compared with usual care (n=3376 patients), medication-related interventions (n=1820 patients) reduced hospital readmissions by 3.8 percentage points within 30 days of discharge (number needed to treat=27, risk ratio (RR) 0.79 (95% CI 0.65 to 0.96)). Meta-regression analysis suggested that readmission rates were reduced by 17% per additional intervention component (RR 0.83 (95% Cl 0.75 to 0.91)). Medication adherence and MRPs may be improved. Effects on mortality were unclear.

Conclusions Studied medication-related interventions reduce all-cause hospital readmissions within 30 days. The treatment effect appears to increase with higher intervention intensities. More evidence is needed for recommendations on adherence, mortality and MRPs.

  • medication safety
  • patient safety
  • transitions in care
  • adverse events, epidemiology and detection
  • health services research

https://doi.org/10.1136/bmjqs-2020-010927

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    Footnotes

    • Contributors Conception and design: SD, SB, AeM and FK. Obtaining of funding: FK, BMB and WSoR. Collection and assembly of data: SD, SB, AeM, FK and CdH. Analysis and interpretation of the data: SD, SB, AeM, FK, GtR, BMB and WSoR. Statistical expertise: GtR. Drafting of the article: SD, SB, AeM and FK. Critical revision of the article for important intellectual content: all authors. Final approval of the article: all authors.

    • Funding This study was supported by a SIA RAAK MKB grant (ID: RAAK.MKB08.011).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.