Medication review interventions to reduce hospital readmissions in older people.

Autor: Dautzenberg L; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Bretagne L; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland., Koek HL; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Tsokani S; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece., Zevgiti S; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece., Rodondi N; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland., Scholten RJPM; Cochrane Netherlands/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Rutjes AW; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland., Di Nisio M; Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy., Raijmann RCMA; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Emmelot-Vonk M; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Jennings ELM; School of Medicine, University College Cork, National University of Ireland, Cork, Ireland.; Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland., Dalleur O; Louvain Drug Research Institute (LDRI), Clinical Pharmacy Research Group, Université catholique de Louvain-UCLouvain, Brussels, Belgium.; Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain-UCLouvain, Brussels, Belgium., Mavridis D; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.; Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France., Knol W; Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 Jun; Vol. 69 (6), pp. 1646-1658. Date of Electronic Publication: 2021 Feb 12.
DOI: 10.1111/jgs.17041
Abstrakt: Objective: To assess the efficacy of medication review as an isolated intervention and with several co-interventions for preventing hospital readmissions in older adults.
Methods: Ovid MEDLINE, Embase, The Cochrane Central Register of Controlled Trials and CINAHL were searched for randomized controlled trials evaluating the effectiveness of medication review interventions with or without co-interventions to prevent hospital readmissions in hospitalized or recently discharged adults aged ≥65, until September 13, 2019. Included outcomes were "at least one all-cause hospital readmission within 30 days and at any time after discharge from the index admission."
Results: Twenty-five studies met the inclusion criteria. Of these, 11 studies (7,318 participants) contributed to the network meta-analysis (NMA) on all-cause hospital readmission within 30 days. Medication review in combination with (a) medication reconciliation and patient education (risk ratio (RR) 0.45; 95% confidence interval (CI) 0.26-0.80) and (b) medication reconciliation, patient education, professional education and transitional care (RR 0.64; 95% CI 0.49-0.84) were associated with a lower risk of all-cause hospital readmission compared to usual care. Medication review in isolation did not significantly influence hospital readmissions (RR 1.06; 95% CI 0.45-2.51). The NMA on all-cause hospital readmission at any time included 24 studies (11,677 participants). Medication review combined with medication reconciliation, patient education, professional education and transitional care resulted in a reduction of hospital readmissions (RR 0.82; 95% CI 0.74-0.91) compared to usual care. The quality of the studies included in this systematic review raised some concerns, mainly regarding allocation concealment, blinding and contamination.
Conclusion: Medication review in combination with medication reconciliation, patient education, professional education and transitional care, was associated with a lower risk of hospital readmissions compared to usual care. An effect of medication review without co-interventions was not demonstrated. Trials of higher quality are needed in this field.
(© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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