Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
J Am Geriatr Soc. 2021 Jun;69(6):1646-1658. doi: 10.1111/jgs.17041. Epub 2021 Feb 12.
To assess the efficacy of medication review as an isolated intervention and with several co-interventions for preventing hospital readmissions in older adults.
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."
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.
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.
评估药物审查作为一种孤立的干预措施以及与多种联合干预措施相结合，预防老年人住院或出院后再入院的效果。
检索 Ovid MEDLINE、Embase、Cochrane 对照试验中心注册库和 CINAHL，以评估药物审查干预措施的有效性，这些干预措施包括或不包括联合干预措施，以预防年龄≥65 岁的住院或近期出院的成年人在 30 天内和索引入院后任何时间再次住院。纳入的结局为“在 30 天内和索引入院后任何时间至少发生一次全因再住院”。
25 项研究符合纳入标准。其中，11 项研究（7318 名参与者）为网络荟萃分析（NMA）提供了数据，分析内容为 30 天内全因再住院。药物审查联合（a）药物重整和患者教育（风险比（RR）0.45；95%置信区间（CI）0.26-0.80）和（b）药物重整、患者教育、专业教育和过渡性护理（RR 0.64；95%CI 0.49-0.84）与降低全因再住院风险相关，而药物审查单独应用与常规护理相比，对降低再住院风险无显著影响（RR 1.06；95%CI 0.45-2.51）。NMA 分析还包括了 24 项研究（11677 名参与者），关于任意时间的全因再住院。药物审查联合药物重整、患者教育、专业教育和过渡性护理与常规护理相比，可降低再住院风险（RR 0.82；95%CI 0.74-0.91）。本系统评价纳入的研究质量存在一些问题，主要涉及分配隐藏、盲法和污染。
与常规护理相比，药物审查联合药物重整、患者教育、专业教育和过渡性护理可降低再住院风险。但药物审查不联合其他干预措施的效果并未得到证实。本领域仍需开展更高质量的试验。
