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Meta-Analysis
. 2016 Dec;82(6):1660-1673.
doi: 10.1111/bcp.13085. Epub 2016 Sep 29.

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

Pierre Renaudin  1   2 , Laurent Boyer  2 , Marie-Anne Esteve  1   3 , Pierre Bertault-Peres  1 , Pascal Auquier  2 , Stéphane Honore  1   3
Affiliations
Meta-Analysis

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

Pierre Renaudin et al. Br J Clin Pharmacol. 2016 Dec.

Abstract

Aims: The aim of this meta-analysis is to examine the impact of in-hospital pharmacist-led medication reviews in paediatric and adult patients.

Methods: Relevant 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 I2 statistic.

Results: We 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).

Conclusion: The 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.

Keywords: clinical pharmacy; medication reconciliation; medication review; meta-analysis; pharmacists; systematic review.

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Figures

Figure 1
Figure 1
Systematic review inclusion and exclusion flowchart
Figure 2
Figure 2
Forest plot of the effect of medication review on 30 days' all‐cause readmissions and/or ED visits and all cause readmission and/or ED visits between 2 months and 12 months after hospital discharge
Figure 3
Figure 3
Forest plot of the effect of medication review on 30 days' all‐cause readmissions, all‐cause readmission between 2 months and 12 months after hospital discharge, all‐cause ED visits, drug‐related readmission and all‐cause mortality
Figure 4
Figure 4
Forest plot of the effect of medication review on the length of hospital stay
See this image and copyright information in PMC

References

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