Characteristics of included studies
| Author, Year | Country, Setting | Study design | Intervention | Comparator | Target of intervention | Inclusion | Exclusion | Components of intervention | Comparator | Follow-up Period | Relevant outcomes | Main results |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anderegg et al 201435 | USA, single centre | Before–after | 1664 | 1652 | Admission, discharge | Age 18 years or older, discharge from internal medicine, family medicine, cardiology, or orthopaedic surgery medical | Mental illness/alcohol or drug use; discharge to a rehabilitation unit/long-term care facility, readmission for chemotherapy/radiation therapy/rehabilitation therapy | Admission MedRec, Discharge MedRec, patient education, medication calendar | Control group (admission MedRec as needed) | 30 days | Readmission, Readmission and/or ED visit | 30-day readmission and/or ED visit (general population): NS; 30-day readmission (high-risk): 12.3% (I) vs 17.8% (U), p=0.042 |
| Bolas et al 200450 | Ireland, single centre | RCT | 81 | 81 | Inpatient stay, discharge, postdischarge | Age 55 years or older, at least 3 regular medications | Transfer to another hospital or nursing home, unable to communicate, mental illness or alcohol-related admission, follow-up was declined | Medication liaison service (comprehensive medication history, discharge letter faxed to GP and community pharmacist, medicines record sheet, discharge counselling, home visit/telephone call) | Standard clinical pharmacy service (not include discharge counselling and liaison service) | 3 month | Readmission, hospital stay (following readmission) | Readmission rate: p>0.05; Length of stay: p>0.05 |
| Eisenhower 201436 | US, single centre | Before–after | 25 | 60 | Discharge | Age 65 years or older, with history of COPD | Left the hospital without medical advice, death within 30 days of discharge | MedRec at discharge, Medication reconciliation form, discharge summary | Usual care (pharmacist was not present during baseline data collection) | 30 days | Readmission | Readmission rate: 16% (I) vs 22.2% (U) |
| Farris et al 2014 37 | USA, Single centre | RCT | Minimal=312 Enhanced=311 | 313 | Admission, inpatient stay, discharge | 18 years or older, English or Spanish speaker, diagnosis of HPN, hyperlipidaemia, HF, CAD, MI, stroke, TIA, asthma, COPD or receiving oral anticoagulation | Admission to psychiatry, surgery or haematology/oncology service, could not use a telephone, had life expectancy <6 months, had dementia or cognitive impairment | Admission MedRec, patient education during inpatient stay, discharge counselling, discharge medication list, telephone call, care plan faxed to primary care physician/community pharmacist | Usual care (admission MedRec, nurse-led discharge counselling and medication list) | 90 days | ADEs, readmission, ED visit, readmission and/or ED visit | 16% experienced an AE, Healthcare utilisation at 30 days and 90 days: NS |
| Gardella et al 201238 | US, multicentre | Before–after | 1624 | 7335 | Preadmission to post discharge | NA | NA | Preadmission medication list, patient education | Historical control group (preadmission medication list gathered by nurse) | 60 days | ADE, ED visits and readmission | 30-day readmission: 6% (I) vs 13.1% (U) (OR 2.34, 95% CI 1.87 to 2.94, p<0.001); 60-day readmission: 2.7% (I) vs 7.7% (U) (OR 3.02, 95% CI 2.18 to 4.19, p<0.001) |
| Gillespie et al 200946 | Sweden, single centre | RCT | 182 | 186 | Admission, inpatient stay and discharge | Age 80 or older | Previous admission during the study period | Admission MedRec, discharge counselling, medication review, faxing discharge summary to primary care physicians, telephone follow-up at 2 months | Usual care (without pharmacist involvement) | 12 month | Readmissions, ED visits, mortality | Readmissions: 58.2% (I) vs 59.1% (U) (OR 0.96, 95% CI 0.64 to 1.4); ED visits per patient: 0.35 (I) vs 0.66 (U) (OR 0.53, 95% CI 0.37 to 0.75) |
| Hawes et al 201439 | US, single centre | RCT | 24 | 37 | Discharge and post discharge | High-risk patients ( HF, COPD, hyperglycaemic crisis, stroke ,NSTEM, more than 3 hospitalisations in the past 5 years., 8 or more medications on discharge) | Age <18 years, inability to communicate in English, unable to follow-up (no transportation and no telephone access), transfer to facilities other than primary care, decisional impairment, incarceration | Post discharge medication reconciliation | Usual care (with no pharmacist intervention) | 30 days | Readmission, ED visit, readmission and /or ED visit | ED visit: 0 (I) vs 29.7% (U), p=0.004; Readmission: 0 (I) vs 32.4% (U), p=0.002; Composite of hospitalisation or ED visit: 0 (I) vs 40.5% (C), p<0.001 |
| Hellstrom et al 201147 | Sweden, single centre | Before–after | 109 | 101 | Admission, inpatient stay, discharge | Age 65 years or older, at least one regular medication | Staying during the implementation period | LIMM model, admission and discharge MedRec, medication review and monitoring, quality control of discharge MedRec | Standard care (no formal MedRec by clinical pharmacists) | 3 month | Readmission and ED visit,ADE-related hospital visit | ED visit and readmission: 45/108 (I) vs 41/100 (U) Mortality, 3 month: 9/108 (I) vs 9/100 (U) ADE-related revisit: 6/108 (I) vs 12/100 (U) |
| Hellstrom et al 201248 | Sweden, single centre | Before–after | 1216 | 2758 | Admission, inpatient stay | High-risk patients (age ≥65 years with any of HF, RF) | NA | Admission MedRec, structured medication reviews, follow-up at least two times a week | Usual care (no clinical pharmacists working in the wards) | 6 month | ED visits, hospital admissions and mortality | ED visit: 48.8% (I) vs 51.3% (U) (HR 0.95, 95% CI 0.86 to 1.04); All ED visits, hospitalisation or death: 58.9% (I) vs 61.2% (U) (HR 0.96, 95% CI 0.88 to 1.04) Mortality: 18.2% (I) vs 17.3% (U), p=0.55 |
| Koehler et al 200940 | US, single centre | RCT | 20 | 21 | Admission, discharge and post discharge | Age 70 years or older, ≥5 medications, ≥3 chronic comorbid conditions, assisted living, English language, phone contact | Primarily surgical procedure, life expectancy ≤6 months, residence in long-term care facility, refusal to participate, not enrolled within 72 h. | Targeted care bundle, medication reconciliation and education, follow-up call, enhanced discharge form | Usual care (nurse and care coordination staff providing care) | 60 days | Readmission and/or ED visits | 30 days readmission/ED visits: 2/20 (I) vs 8/21 (U), p= 0.03; 60days readmission/ED visits: 6/20 (I) vs 9/21 (U), p= 0.52 |
| Pal et al 201341 | US, single centre | NRCT | 537 | 192 | Discharge | Age 18 years or older, at least 10 regular medications | NA | Patient counselling, pharmacist medication reconciliation, medication calendar | Usual care (without discharge review by pharmacist) | 30 days | Readmission | 30 days readmission: 16.8% (I) vs 26.0% (U), p=0.006 ADE prevented: 52.8% |
| Schnipper et al 200642 | US, single centre | RCT | 92 | 84 | Inpatient stay, discharge, post discharge | Discharge to home, contacted 30 days after discharge, spoke English, cared for primary care physician/internal medicine resident | NA | Discharge medication reconciliation, telephone follow-up, medication review, standard email template, patient counselling | Usual care (medication review by a pharmacist and discharge counselling by a nurse) | ADEs-related hospital visit, readmission and/or ED visit | Preventable ADE: 1% (I) vs 11% (U), p=0.01; ED visit/readmission: 30% (I) vs 30% (U), p>0.99; preventable medication-related healthcare utilisation: 1% (I) vs 8% (U), p= 0.03 | |
| Scullin et al 200749 | Ireland, multicentre | RCT | 371 | 391 | Admission, inpatient stay, discharge | Age 65 years or older, at least 4 regular medications, taking antidepressants, previous admission in the past 6 months, taking intravenous antibiotics | Scheduled admissions and admissions from private nursing homes | Integrated medicines management service admission and discharge MedRec, inpatient medication review and counselling, telephone follow-up | Usual care (did not receive integrated medicines management service) | 12 month | Length of hospital stay, readmission | LoS reduced by 2 days for intervention vs usual care, p=0.003 Readmissions per patient: 0.8 (I) vs 1 (U) |
| Stowasser et al 200251 | Australia, multicentre | RCT | 113 | 127 | Admission, discharge | Return to the community following discharge | Outpatients, discharge to hostel or nursing home, previous enrolment, unable to provide consent and follow-up | Medication liaison service—medication history confirmation with community healthcare professionals (telephone, faxing), 30 days post follow-up | Usual care (no medication liaison service) | 30 days | Mortality, readmission, ED visit | Mortality, 30 days: 2/113 (I) vs 3/127 (U): NS Readmissions: 12/113 (I) vs 17/127 (U) ED visit per patient: 7.54 (I) vs 9.94 (U) |
| Walker et al 200943 | US, single centre | NRCT | 138 | 366 | Discharge, post discharge | Age 18 years or older, 5 or more regular medications, receiving 1 or more targeted medications, having 2 or more therapy modification, unable to manage their medication, receiving a medication requiring therapeutic drug monitoring | Non-English speaking, stay of 21 days or longer | Patient interviews, follow-up plan, medication counselling, telephone follow-up | Usual care (nurse-led service) | 30 days | Readmission, ED visit, readmission and/or ED visit | Readmission, 14 days: 12.6% (I) vs 11.5% (U), p=0.65; Readmission, 30 days: 22.1% (I) vs 18.0% (U), p=0.17; Readmissions and/or ED visits: 27.4% (I) vs 25.7% (U), p= 0.61 |
| Warden et al 201444 | US, single centre | Before–after | 35 | 115 | Admission, inpatient stay, discharge | Age 18–85 years, systolic dysfunction (EF ≤40) | Diastolic dysfunction, valve replacement/left ventricular assist device | Medication reconciliation (admission and discharge), discharge instructions, telephone follow-up | Historical control group (physicians—admission MedRec; nurses- discharge counselling) | 30 days | Readmission | All cause readmission, 30-day :17% (I) vs 38% (U) (RR 0.45, 95% CI 0.21 to 0.96, p=0.02), 30 days HF-related readmission: 6%(I) vs 18% (U) (RR 0.31, 95% CI 0.08 to 1.27, p=0.11) |
| Wilkinson et al 201145 | US, single centre | NRCT | 229 | 440 | Discharge | Age 18 years or older, English speaking, patients with depression, receiving high-risk medications and polypharmacy, poor health literacy, having an absence of social support, prior hospitalisation within the past 6 months | Refusal of pharmacist education, transfer to a skilled nursing facility, or discharge when the pharmacist was not available | Medication history at admission, during hospitalisation and discharge, patient education on discharge | Control group (pharmacists not provide medication counselling at discharge) | 30 days | Readmission | Readmission rate: 15.7% (I) vs 21.6% (U) (RR 0.728, 95% CI 0.514 to 1.032, p =0.04) |
ADE, adverse drug event; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; D, days; ED, emergency department; EF, ejection fraction; GP, general practitioner; HF, heart failure; HPN, hypertension; I, intervention; IV, intravenous; LIMM, Lund Integrated Medicines Management; LoS, length of stay; MedRec, medication reconciliation; MI, myocardial infarction; NA, not available; NS, non-significant; NSEMI, non-ST segment elevation myocardial infarction; RCT, randomised controlled trials; RF, renal failure; RR, relative risk; TIA, transit ischaemic attack; U, usual care.