Meds reviews reduce drug-related readmissions, but evidence poor

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French study finds evidence that hospital medication reviews may have a positive impact – but overall evidence remains flimsy

Researchers from the Hôpitaux de Marseille, France, conducted a systemic review and meta-analysis of 19 randomised controlled trials that looked at pharmacist-led medication reviews in hospital.

Analysis of the data, comprising 4805 patients, suggested that readmission rates were similar between experimental and control groups, except where drug-related readmissions were concerned.

Here, there was a lower relative risk in the intervention group when compared with the control group. All-cause ED trips were also lower.

The study also found that clinical medication reviews and adherence reviews had an impact on adherence.

“Pharmacist-led medication reviews were associated with a decrease in the number of ED visits and drug-related readmissions,” say the authors.

“The impact of medication reviews on the length of hospital stay and adherence remains unclear. Based on the results of this meta-analysis and other meta-analyses, it seems very unlikely, as might be expected, that medication reviews have an impact on mortality.

“However, the impact on patient quality of life may be more in question; indeed, the variety of the assessments used did not enable us to determine any effects.”

The researchers point out the evidence in their study is low quality, and “more high-quality randomised clinical trials are needed to assess the impact of pharmacist-led medication reviews on patient-relevant outcomes, including adherence and quality of life.”

A randomised controlled trial with a large number of subjects, using a standardised medication review in populations at risk for drug-related readmission, is necessary to gain more understanding of its impact, they conclude.

See the study, published in the British Journal of Pharmacology

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1 Comment

  1. Drugby

    Three different levels of medication review were included in this systematic review and meta-analysis:
    (i) prescription review
    (ii) adherence review (AR)
    (iii) clinical medication review (CMR)

    Only the third one, a clinical medication review, involved communication and collaboration with the patient’s community pharmacy and medical practitioner. They were all in-hospital medication reviews. Only 9 of the studies included a follow-up after hospital discharge. Only one RCT included in the meta-analysis was Australian: Danielle Stowasser’s trial of medication liaison services published in 2002.

    The results did show that pharmacist-led med reviews do have an impact of drug-related readmissions, all-cause ED visits and adherence; albeit with low quality evidence. But it is still evidence of benefit. The 30% reduction in all-cause ED visits is likely to represent significant cost savings.

    The majority of studies (80%) reported a significant improvement in adherence to medication as a result of the pharmacist-led medication review.

    The authors acknowledge it is difficult to study the impact of medication reviews alone because the process is affected by the patient’s overall care and many intervening factors.

    This just reinforces the need for collaboration in pharmacist-led medication reviews across the continuum with the patient’s community pharmacist and GP, and the need for follow-up after the initial intervention.

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