Effect of a medicines management model on medication‐related readmissions in older patients admitted to a medical acute admission unit—A randomized controlled trial

Graabæk, Trine; Hedegaard, Ulla; Christensen, Mikkel B.; Clemmensen, Marianne Hald; Knudsen, Torben; Aagaard, Lise

doi:10.1111/jep.13013

Cited by 27 publications

(61 citation statements)

References 36 publications

(43 reference statements)

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“…Twelve studies scored low in all five risks of bias domains [ 24 , 25 , 28 , 34 , 35 , 38 , 41 , 42 , 44–47 ] (see Supplementary Material A4 ). Nine studies were rated as having the highest risk of bias [ 26 , 27 , 29 , 31 , 33 , 37 , 39 , 40 , 43 ] based on randomisation and allocation concealment methods.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Abstract 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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…One study found that point-of-care assessment led to a higher proportion of successful discharges in four hospitals [28], while another study found that hospital costs had an impact on the overall increase in successful discharges [29]. Otherwise, pre-discharge planning was not found to affect readmission rates [30,31,32,33,34] although it was associated with slight improvements in quality of life [27,32] and increased patient understanding of their treatment [32,35]. A systematic review by Ogilvie (2005) found that having acute medical assessment units for children within the hospital, enabled children to be admitted less and had lower rates of readmission [36].…”

Section: Resultsmentioning

confidence: 99%

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Coffey

Leahy‐Warren

Savage

et al. 2019

IJERPH

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Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

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“…The data provided in this study were obtained from a pool of 400 patients who all took part in the intervention arm of a randomized controlled trial conducted by one of the authors (TG) at the Hospital of South West Jutland from April 2013 to December 2014. 19 The SMP was launched at the hospital on 24 February 2014. Patients included in the randomized controlled trial were acutely admitted medical patients aged 65 years or above, whereas extremely ill, isolated and terminal patients, patients without a Danish social security number and patients unable to give informed consent were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…A full description of the intervention is described elsewhere, 19 but described briefly here. During the reconciliation, the clinical pharmacist reviewed the electronic hospital patient record, SMP and correspondence notes from nursing homes and general practitioners when available.…”

Section: Methodsmentioning

confidence: 99%

Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Graabæk

Terkildsen

Lauritsen

et al. 2019

Therapeutic Advances in Drug Safety

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Transitions of care may result in medication errors, when information about a patient’s medications is not communicated sufficiently. In this clinical record review study, we aimed to evaluate the frequency of undocumented medication discrepancies at discharge from hospital and evaluate which patient characteristics could be associated with undocumented medication discrepancies. Preadmission medication lists were compared against the medication list in the discharge letters, taking into account medication changes documented in the patient record throughout the inpatient stay and in the discharge summary. Out of 200 patients, 174 (87%) were affected by at least one undocumented medication discrepancy, mostly for regular medication. Of the 1972 medications used, 744 (38%) medications were changed without documentation in the patient record, the majority being over-the-counter supplements and herbal medications. Polypharmacy at admission and discharge was associated with increased undocumented medication discrepancies. This study indicates a lack of medication reconciliation during inpatient stay. Correct and complete medication lists at admission and discharge may resolve many of these discrepancies, supporting patient safety at transitions of care.

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Effect of a medicines management model on medication‐related readmissions in older patients admitted to a medical acute admission unit—A randomized controlled trial

Cited by 27 publications

References 36 publications

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

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

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

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