药剂师主导的药物重整计划在医院转衔期间对临床结局的有效性：系统评价和荟萃分析。
Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis.
机构信息
Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia School of Pharmacy, University of Gondar, Gondar, Ethiopia.
Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia.
出版信息
BMJ Open. 2016 Feb 23;6(2):e010003. doi: 10.1136/bmjopen-2015-010003.
OBJECTIVES
Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients' clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity.
RESULTS
17 studies involving 21,342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results.
CONCLUSION
Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.
目的
药剂师在提供药物重整方面发挥作用。然而，关于患者临床结局的有效性数据似乎尚无定论。因此，本研究旨在系统地调查药剂师主导的药物重整计划对医院转院时临床结局的影响。
设计
系统评价和荟萃分析。
方法
我们从建库到 2014 年 12 月在 PubMed、MEDLINE、EMBASE、IPA、CINHAL 和 PsycINFO 中进行了检索。纳入的研究均为比较药剂师主导的药物重整干预与常规护理在改善药物重整方案方面有效性的英文发表研究。采用随机效应模型进行荟萃分析，并进行亚组分析以确定异质性的来源。
结果
纳入了 17 项涉及 21342 名成年患者的研究。8 项研究为随机对照试验（RCT）。大多数研究针对多个转院，并比较了在随访的前 30 天内包括电话随访/家访、患者咨询或两者的全面药物重整计划。汇总的相对风险显示，干预组的药物相关不良事件导致的医院复诊（RR 0.33；95%CI 0.20 至 0.53）、急诊（RR 0.72；95%CI 0.57 至 0.92）和医院再入院（RR 0.81；95%CI 0.70 至 0.95）的减少更为显著。干预组与常规护理组在死亡率（RR 1.05；95%CI 0.95 至 1.16）和复合再入院和/或急诊就诊（RR 0.95；95%CI 0.90 至 1.00）方面的汇总数据无差异。然而，在再入院和急诊就诊方面的结果存在显著的异质性。基于研究设计和结局时间的亚组分析未显示出统计学意义的结果。
结论
药剂师主导的药物重整计划可有效改善医院后的医疗保健利用情况。本综述支持实施包括旨在提高药物安全性的某些环节的药剂师主导的药物重整计划。
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