Medication review in hospitalised patients to reduce morbidity and mortality

Mikkel Christensen, Andreas Lundh

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Resumé

BACKGROUND: Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review performed in adult hospitalised patients may lead to better patient outcomes.

OBJECTIVES: We examined whether the delivery of a medication review by a physician, pharmacist or other healthcare professional improves the health outcomes of hospitalised adult patients compared to standard care.

SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Specialised Register (August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library 2011, Issue 8; MEDLINE (1946 to August 2011); EMBASE (1980 to August 2011); CINAHL (1980 to August 2011); International Pharmaceutical Abstracts (1970 to August 2011); and Web of Science (August 2011). In addition we searched reference lists of included trials and relevant reviews. We searched trials registries and contacted experts to identify additional published and unpublished trials. We did not apply any language restrictions.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) of medication review in hospitalised adult patients. We excluded trials of outclinic and paediatric patients. Our primary outcome was all-cause mortality and secondary outcomes included hospital readmission, emergency department contacts and adverse drug events.

DATA COLLECTION AND ANALYSIS: Two review authors independently included trials, extracted data and assessed trials for risk of bias. We contacted trial authors for clarification of data and additional unpublished data. We calculated relative risks for dichotomous data and mean differences for continuous data (with 95% confidence intervals (CIs)).

MAIN RESULTS: We identified 4647 references and included five trials (1186 participants). Follow-up ranged from 30 days to one year. We found no evidence of effect on all-cause mortality (risk ratio (RR) 0.98; 95% CI 0.78 to 1.23) and hospital readmissions (RR 1.01; 95% CI 0.88 to 1.16), but a 36% relative reduction in emergency department contacts (RR 0.64; 95% CI 0.46 to 0.89).

AUTHORS' CONCLUSIONS: It is uncertain whether medication review reduces mortality or hospital readmissions, but medication review seems to reduce emergency department contacts. However, the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up, important treatment effects may have been overlooked. Therefore, medication review should preferably be undertaken in the context of clinical trials. High quality trials with long follow-up are needed before medication review should be implemented.

OriginalsprogEngelsk
ArtikelnummerCD008986
TidsskriftCochrane Database of Systematic Reviews
Udgave nummer2
Antal sider84
ISSN1361-6137
DOI
StatusUdgivet - 2016
Udgivet eksterntJa

Fingeraftryk

Patient Readmission
Confidence Intervals
Hospital Emergency Service
Odds Ratio
Drug-Related Side Effects and Adverse Reactions
Pharmacists
MEDLINE
Pharmaceutical Preparations
Libraries
Uncertainty
Cost-Benefit Analysis
Prescriptions
Registries
Language
Randomized Controlled Trials
Clinical Trials
Organizations
Pediatrics
Delivery of Health Care
Physicians

Citer dette

@article{aedb3464067c45bca500639695ec4cfe,
title = "Medication review in hospitalised patients to reduce morbidity and mortality",
abstract = "BACKGROUND: Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review performed in adult hospitalised patients may lead to better patient outcomes.OBJECTIVES: We examined whether the delivery of a medication review by a physician, pharmacist or other healthcare professional improves the health outcomes of hospitalised adult patients compared to standard care.SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Specialised Register (August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library 2011, Issue 8; MEDLINE (1946 to August 2011); EMBASE (1980 to August 2011); CINAHL (1980 to August 2011); International Pharmaceutical Abstracts (1970 to August 2011); and Web of Science (August 2011). In addition we searched reference lists of included trials and relevant reviews. We searched trials registries and contacted experts to identify additional published and unpublished trials. We did not apply any language restrictions.SELECTION CRITERIA: We included randomised controlled trials (RCTs) of medication review in hospitalised adult patients. We excluded trials of outclinic and paediatric patients. Our primary outcome was all-cause mortality and secondary outcomes included hospital readmission, emergency department contacts and adverse drug events.DATA COLLECTION AND ANALYSIS: Two review authors independently included trials, extracted data and assessed trials for risk of bias. We contacted trial authors for clarification of data and additional unpublished data. We calculated relative risks for dichotomous data and mean differences for continuous data (with 95{\%} confidence intervals (CIs)).MAIN RESULTS: We identified 4647 references and included five trials (1186 participants). Follow-up ranged from 30 days to one year. We found no evidence of effect on all-cause mortality (risk ratio (RR) 0.98; 95{\%} CI 0.78 to 1.23) and hospital readmissions (RR 1.01; 95{\%} CI 0.88 to 1.16), but a 36{\%} relative reduction in emergency department contacts (RR 0.64; 95{\%} CI 0.46 to 0.89).AUTHORS' CONCLUSIONS: It is uncertain whether medication review reduces mortality or hospital readmissions, but medication review seems to reduce emergency department contacts. However, the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up, important treatment effects may have been overlooked. Therefore, medication review should preferably be undertaken in the context of clinical trials. High quality trials with long follow-up are needed before medication review should be implemented.",
keywords = "Aged, Cause of Death, Emergency Service, Hospital, Humans, Inpatients, Medication Reconciliation, Patient Readmission, Polypharmacy, Randomized Controlled Trials as Topic, Journal Article, Research Support, Non-U.S. Gov't, Review",
author = "Mikkel Christensen and Andreas Lundh",
year = "2016",
doi = "10.1002/14651858.CD008986.pub2",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1361-6137",
publisher = "John Wiley & Sons Ltd",
number = "2",

}

Medication review in hospitalised patients to reduce morbidity and mortality. / Christensen, Mikkel; Lundh, Andreas.

I: Cochrane Database of Systematic Reviews, Nr. 2, CD008986, 2016.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

TY - JOUR

T1 - Medication review in hospitalised patients to reduce morbidity and mortality

AU - Christensen, Mikkel

AU - Lundh, Andreas

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review performed in adult hospitalised patients may lead to better patient outcomes.OBJECTIVES: We examined whether the delivery of a medication review by a physician, pharmacist or other healthcare professional improves the health outcomes of hospitalised adult patients compared to standard care.SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Specialised Register (August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library 2011, Issue 8; MEDLINE (1946 to August 2011); EMBASE (1980 to August 2011); CINAHL (1980 to August 2011); International Pharmaceutical Abstracts (1970 to August 2011); and Web of Science (August 2011). In addition we searched reference lists of included trials and relevant reviews. We searched trials registries and contacted experts to identify additional published and unpublished trials. We did not apply any language restrictions.SELECTION CRITERIA: We included randomised controlled trials (RCTs) of medication review in hospitalised adult patients. We excluded trials of outclinic and paediatric patients. Our primary outcome was all-cause mortality and secondary outcomes included hospital readmission, emergency department contacts and adverse drug events.DATA COLLECTION AND ANALYSIS: Two review authors independently included trials, extracted data and assessed trials for risk of bias. We contacted trial authors for clarification of data and additional unpublished data. We calculated relative risks for dichotomous data and mean differences for continuous data (with 95% confidence intervals (CIs)).MAIN RESULTS: We identified 4647 references and included five trials (1186 participants). Follow-up ranged from 30 days to one year. We found no evidence of effect on all-cause mortality (risk ratio (RR) 0.98; 95% CI 0.78 to 1.23) and hospital readmissions (RR 1.01; 95% CI 0.88 to 1.16), but a 36% relative reduction in emergency department contacts (RR 0.64; 95% CI 0.46 to 0.89).AUTHORS' CONCLUSIONS: It is uncertain whether medication review reduces mortality or hospital readmissions, but medication review seems to reduce emergency department contacts. However, the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up, important treatment effects may have been overlooked. Therefore, medication review should preferably be undertaken in the context of clinical trials. High quality trials with long follow-up are needed before medication review should be implemented.

AB - BACKGROUND: Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review performed in adult hospitalised patients may lead to better patient outcomes.OBJECTIVES: We examined whether the delivery of a medication review by a physician, pharmacist or other healthcare professional improves the health outcomes of hospitalised adult patients compared to standard care.SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Specialised Register (August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library 2011, Issue 8; MEDLINE (1946 to August 2011); EMBASE (1980 to August 2011); CINAHL (1980 to August 2011); International Pharmaceutical Abstracts (1970 to August 2011); and Web of Science (August 2011). In addition we searched reference lists of included trials and relevant reviews. We searched trials registries and contacted experts to identify additional published and unpublished trials. We did not apply any language restrictions.SELECTION CRITERIA: We included randomised controlled trials (RCTs) of medication review in hospitalised adult patients. We excluded trials of outclinic and paediatric patients. Our primary outcome was all-cause mortality and secondary outcomes included hospital readmission, emergency department contacts and adverse drug events.DATA COLLECTION AND ANALYSIS: Two review authors independently included trials, extracted data and assessed trials for risk of bias. We contacted trial authors for clarification of data and additional unpublished data. We calculated relative risks for dichotomous data and mean differences for continuous data (with 95% confidence intervals (CIs)).MAIN RESULTS: We identified 4647 references and included five trials (1186 participants). Follow-up ranged from 30 days to one year. We found no evidence of effect on all-cause mortality (risk ratio (RR) 0.98; 95% CI 0.78 to 1.23) and hospital readmissions (RR 1.01; 95% CI 0.88 to 1.16), but a 36% relative reduction in emergency department contacts (RR 0.64; 95% CI 0.46 to 0.89).AUTHORS' CONCLUSIONS: It is uncertain whether medication review reduces mortality or hospital readmissions, but medication review seems to reduce emergency department contacts. However, the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up, important treatment effects may have been overlooked. Therefore, medication review should preferably be undertaken in the context of clinical trials. High quality trials with long follow-up are needed before medication review should be implemented.

KW - Aged

KW - Cause of Death

KW - Emergency Service, Hospital

KW - Humans

KW - Inpatients

KW - Medication Reconciliation

KW - Patient Readmission

KW - Polypharmacy

KW - Randomized Controlled Trials as Topic

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

KW - Review

U2 - 10.1002/14651858.CD008986.pub2

DO - 10.1002/14651858.CD008986.pub2

M3 - Review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1361-6137

IS - 2

M1 - CD008986

ER -