Foot Holly, Scott Ian, Sturman Nancy, Whitty Jennifer A, Rixon Kylie, Connelly Luke, Williams Ian, Freeman Christopher
School of Pharmacy, The University of Queensland, Woolloongabba, Australia.
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Australia.
Res Social Adm Pharm. 2022 Jun;18(6):2922-2943. doi: 10.1016/j.sapharm.2021.07.015. Epub 2021 Jul 16.
Readmissions to hospital due to medication-related problems are common and may be preventable. Pharmacists act to optimise use of medicines during care transitions from hospital to community.
To assess the impact of pharmacist-led interventions, which include communication with a primary care physician (PCP) on reducing hospital readmissions.
PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science were searched for articles published from inception to March 2021 that described interventions involving a pharmacist interacting with a PCP in regards to medication management of patients recently discharged from hospital. The primary outcome was effect on all-cause readmission expressed as Mantel-Haenszel risk ratio (RR) derived from applying a random effects model to pooled data. Sensitivity analysis was also conducted to investigate differences between randomised controlled trials (RCTs) and non-RCTs. The GRADE system was applied in rating the quality of evidence and certainty in the estimates of effect.
In total, 37 studies were included (16 RCTs and 29 non-RCTs). Compared to control patients, the proportion of intervention patients readmitted at least once was significantly reduced by 13% (RR = 0.87, CI:0.79-0.97, p = 0.01; low to very low certainty of evidence) over follow-up periods of variable duration in all studies combined, and by 22% (RR = 0.78, CI:0.67-0.92; low certainty of evidence) at 30 day follow-up across studies reporting this time point. Analysis of data from RCTs only showed no significant reduction in readmissions (RR = 0.92, CI:0.80-1.06; low certainty of evidence).
The totality of evidence suggests pharmacist-led interventions with PCP communication are effective in reducing readmissions, especially at 30 days follow-up. Future studies need to adopt more rigorous study designs and apply well-defined patient eligibility criteria.
因药物相关问题再次入院的情况很常见，且可能是可预防的。药剂师致力于在从医院到社区的护理过渡期间优化药物使用。
评估由药剂师主导的干预措施的影响，其中包括与初级保健医生（PCP）沟通对减少医院再入院的影响。
检索了PubMed、EMBASE、Cochrane对照试验中央注册库、CINAHL和科学网，查找从创刊到2021年3月发表的文章，这些文章描述了涉及药剂师与PCP就近期出院患者的药物管理进行互动的干预措施。主要结局是对全因再入院的影响，以通过对汇总数据应用随机效应模型得出的Mantel-Haenszel风险比（RR）表示。还进行了敏感性分析，以调查随机对照试验（RCT）和非RCT之间的差异。采用GRADE系统对证据质量和效应估计的确定性进行评级。
总共纳入了37项研究（16项RCT和29项非RCT）。与对照患者相比，在所有研究合并的不同随访期内，干预患者至少再次入院一次的比例显著降低了13%（RR = 0.87，CI：0.79 - 0.97，p = 0.01；证据确定性为低至极低），在报告该时间点的所有研究中，30天随访时降低了22%（RR = 0.78，CI：0.67 - 0.92；证据确定性为低）。仅对RCT数据的分析显示再入院率没有显著降低（RR = 0.92，CI：0.80 - 1.06；证据确定性为低）。
总体证据表明，由药剂师主导并与PCP沟通的干预措施在减少再入院方面是有效的，尤其是在30天随访时。未来的研究需要采用更严格的研究设计并应用明确的患者纳入标准。
