Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

被引:85
作者
Tomlinson, Justine [1 ,2 ]
Cheong, V-Lin [3 ]
Fylan, Beth [1 ,4 ]
Silcock, Jonathan [1 ]
Smith, Heather [2 ]
Karban, Kate [5 ]
Blenkinsopp, Alison [1 ]
机构
[1] Univ Bradford, Fac Life Sci, Sch Pharm & Med Sci, Bradford BD7 1DP, W Yorkshire, England
[2] Leeds Teaching Hosp NHS Trust, St Jamess Univ Hosp, Med Management & Pharm Serv, Leeds LS9 7TF, W Yorkshire, England
[3] Sheffield Teaching Hosp NHS Fdn Trust, Pharm Dept, Sheffield S10 2JF, S Yorkshire, England
[4] Bradford Teaching Hosp NHS Fdn Trust, Bradford Inst Hlth Res, Bradford BD9 6RJ, W Yorkshire, England
[5] Univ Bradford, Fac Life Sci, Bradford BD7 1DP, W Yorkshire, England
基金
美国国家卫生研究院;
关键词
medication management; systematic review; continuity of care; hospital discharge; older people; DISCHARGE-PLANNING INTERVENTION; PHARMACIST INTERVENTION; READMISSIONS; MANAGEMENT; SERVICE; VISITS; IMPACT; ADULTS; TRIAL; RISK;
D O I
10.1093/ageing/afaa002
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background:: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods:: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results:: twenty-four studies (total participants= 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion:: our results suggest that interventions that best support older patients' medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.
引用
收藏
页码:558 / 569
页数:12
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