Background

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.

Objective

To assess the impact of pharmacist-led interventions, which include communication with a primary care physician (PCP) on reducing hospital readmissions.

Methods

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.

Results

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).

Conclusions

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.

中文翻译：

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初级保健中药剂师和医生合作对减少再入院的影响：系统评价和荟萃分析

背景

由于药物相关问题而再次入院是很常见的，并且可能是可以预防的。在从医院到社区的护理过渡期间，药剂师采取行动优化药物的使用。

客观的

评估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) 进行沟通以减少再入院。

方法

搜索了 PubMed、EMBASE、Cochrane Central Register of Controlled Trials、CINAHL 和 Web of Science，以查找从开始到 2021 年 3 月发表的文章，这些文章描述了涉及药剂师与 PCP 互动的干预措施，涉及对最近出院患者的药物管理。主要结果是对全因再入院的影响，以 Mantel-Haenszel 风险比 (RR) 表示，该风险比源自将随机效应模型应用于汇总数据。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。GRADE 系统用于评估证据质量和评估效果的确定性。

结果

总共纳入了 37 项研究（16 项 RCT 和 29 项非 RCT）。与对照组患者相比，在变量的随访期内，至少再次入院的干预患者比例显着降低了 13%（RR = 0.87，CI：0.79-0.97，p = 0.01；证据质量低至极低）所有研究的持续时间加起来，并且在报告该时间点的研究的 30 天随访中增加了 22%（RR = 0.78，CI：0.67–0.92；证据质量低）。对 RCT 数据的分析仅显示再入院率没有显着降低（RR = 0.92，CI：0.80-1.06；证据质量低）。

结论

全部证据表明，药剂师主导的 PCP 沟通干预可有效减少再入院，尤其是在 30 天的随访中。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资格标准。