Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
Department of Pharmacy, Federal University of Paraiba, João Pessoa, Brazil.
J Hosp Med. 2020 Jan 1;15(1):52-59. doi: 10.12788/jhm.3182. Epub 2019 Mar 20.
Transitions of care can contribute to medication errors and other adverse drug events.
The aim of this study was to evaluate the impact of pharmacist-led discharge counseling on hospital readmission and emergency department visits through a systematic review and meta-analysis.
Lectronic searches were performed in PubMed, Scopus, and DOAJ (Directory of Open Access Journals), along with a manual search (July 2017). PROSPERO registration no. CRD42017068444.
Two independent reviewers performed all the steps of the systematic review process (screening of titles and abstracts, full-text appraisal, data extraction, and quality assessment), with contributions from a third researcher. We included randomized controlled trials (RCTs) reporting data on pharmacist-led discharge counseling.
Primary extracted outcomes were emergency department visits and hospital readmission rates.
Meta-analyses of intervention versus usual care for hospital readmission and emergency department visit rates were performed using the inverse variance method. Results are reported as risk ratios (RRs) with 95% confidence intervals (CIs). Prediction intervals (PIs) were also calculated. Sensitivity and subgroup analyses were performed. A total of 21 RCTs were included in the qualitative synthesis and 18 in the meta-analyses (n = 7,244 patients). The original meta-analysis revealed a significant difference in the impact between pharmacist-led discharge counseling and usual care on overall hospital readmission (RR = 0.864 [95% CI 0.763-0.997], P = .020) and emergency department (RR = 0.697 [95% CI 0.535-0.907], P = .007) visits. However, the small number of included studies, the high heterogeneity among trials (I2 between 40% and 60%), and the wide PIs (hospital readmission: PI 0.542-1.186; emergency department visits: PI 0.027-1.367) prevented drawing further conclusions.
Insufficient evidence exists regarding the effect of pharmacist-led discharge counseling on hospital readmission and emergency department visits. Further well-designed clinical trials with defined core outcome sets are needed.
医疗护理交接过程可能导致用药错误和其他药物不良事件。
本研究旨在通过系统评价和荟萃分析评估药师主导的出院咨询对住院再入院和急诊就诊的影响。
电子检索 PubMed、Scopus 和 DOAJ（开放获取期刊目录），并进行了手工检索（2017 年 7 月）。PROSPERO 注册号 CRD42017068444。
两名独立的评审员进行了系统评价过程的所有步骤（标题和摘要筛选、全文评估、数据提取和质量评估），第三名评审员提供了帮助。我们纳入了报告药师主导的出院咨询数据的随机对照试验（RCT）。
主要提取的结果是急诊就诊率和住院再入院率。
使用逆方差法对干预组与常规护理组的住院再入院率和急诊就诊率进行荟萃分析。结果以风险比（RR）和 95%置信区间（CI）表示。还计算了预测区间（PI）。进行了敏感性和亚组分析。共有 21 项 RCT 纳入定性综合分析，18 项纳入荟萃分析（n = 7244 例患者）。原始荟萃分析显示，药师主导的出院咨询与常规护理对总体住院再入院（RR = 0.864 [95%CI 0.763-0.997]，P =.020）和急诊就诊（RR = 0.697 [95%CI 0.535-0.907]，P =.007）的影响存在显著差异。然而，纳入的研究数量较少，试验之间的高度异质性（I2 介于 40%和 60%之间）以及广泛的 PI（住院再入院：PI 0.542-1.186；急诊就诊：PI 0.027-1.367），阻止了进一步的结论。
目前尚无足够证据表明药师主导的出院咨询对住院再入院和急诊就诊的影响。需要进一步设计良好的临床试验，并制定明确的核心结局集。
