The effect of early in‐hospital medication review on health outcomes: a systematic review

Abstract

Aims Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in‐hospital pharmacist‐led medication review on patient‐oriented outcomes based on observed data. Methods We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi‐random methods to allocate subjects to pharmacist‐led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta‐analysis. Results We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] –0.04 days, 95% confidence interval [CI] –1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design. Conclusions Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient‐oriented outcomes. This systematic review failed to identify an effect of pharmacist‐led medication review on health outcomes.

Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials

“…mortality, number of hospital admissions) observed in this systematic review is in line with the findings of other systematic reviews [16–22], although Patterson found conflicting results concerning hospital admissions [14]. In other systematic reviews a positive effect of medication review on some clinical outcomes was suggested only when non RCTs [21], unpublished data [18], co-interventions [15, 18] and/or lengthier interventions (> 3 months) [21] were included.…”

A systematic review of the outcomes reported in trials of medication review in older patients: the need for a core outcome set

“…Outcomes reported in trials of medication review in older patients review [12,15,16,21]. However, our results suggest that the choice to perform meta-analyses on these outcomes are probably related to the high proportion of studies reporting these outcomes as opposed to their relevance.…”

“…However, the heterogeneity of outcomes reported in the RCTs has limited the quality of the conclusions of these systematic reviews. Robust meta-analyses could be performed for only a few outcomes, including hospitalization and death [15][16][17]21]. For other outcomes, results were essentially summarized in a descriptive way because of heterogeneity in the choice and definition of the outcomes [17][18][19][20]22].…”

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

“…They concluded that more research on outcomes and which pharmacist duties are most beneficial to patients is needed. Hohl et al 39 looked at early in-hospital medication reviews by pharmacists. Given the weaknesses in the reviewed studies, the authors recommended high-quality randomised trials to fill the gaps in the evidence.…”