Medication reviews in hospitalised patients for reduced hospital readmission and mortality. Systematic review, meta-analysis and meta-regression of RCTs

IF 12.5 1区医学 Q1 CELL BIOLOGY

Ageing Research Reviews Pub Date : 2025-02-01 DOI:10.1016/j.arr.2025.102661

Miriam Degen , Li-Ju Chen , Ben Schöttker

{"title":"Medication reviews in hospitalised patients for reduced hospital readmission and mortality. Systematic review, meta-analysis and meta-regression of RCTs","authors":"Miriam Degen , Li-Ju Chen , Ben Schöttker","doi":"10.1016/j.arr.2025.102661","DOIUrl":null,"url":null,"abstract":"<div><div>Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing medication reviews and usual care in hospitalised patients regarding hospital readmissions and all-cause mortality by random-effects meta-analyses. Effect size differences by methodological study differences were of special interest. The meta-analysis of all 24 trials on hospital readmissions, including 12,539 participants, showed a statistically significant 8 % decrease in hospital readmissions (risk ratio (RR) [95 % confidence interval]: (0.92 [0.88–0.97], p = 0.002). The number of patient contacts was the most prominent effect modifier in meta-regression (p = 0.003) and the effect of medication reviews was approximately twice as strong (15 %) in 11 trials with 2 or more patient contacts (0.85 [0.78–0.92], p < 0.001). No statistically significant reduction in all-cause mortality was observed in a meta-analysis of all 22 trials with data for this outcome (0.95 [0.86–1.04], p = 0.24), including 12,350 participants. The method of mortality assessment was identified as an effect modifier by meta-regression (p = 0.01). A meta-analysis of 10 trials with complete mortality ascertainment via registries or primary care data showed a significantly 19 % reduced mortality (0.81 [0.70–0.94], p < 0.01). In conclusion, medication reviews reduce the risk of hospital readmission and might also reduce all-cause mortality. Comprehensive mortality assessment was essential for successful trials. Clinical guidelines should recommend medication reviews with multiple patient contacts, involving pharmacists, either for repeated medication reviews or to improve adherence.</div></div>","PeriodicalId":55545,"journal":{"name":"Ageing Research Reviews","volume":"104 ","pages":"Article 102661"},"PeriodicalIF":12.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ageing Research Reviews","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1568163725000078","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CELL BIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing medication reviews and usual care in hospitalised patients regarding hospital readmissions and all-cause mortality by random-effects meta-analyses. Effect size differences by methodological study differences were of special interest. The meta-analysis of all 24 trials on hospital readmissions, including 12,539 participants, showed a statistically significant 8 % decrease in hospital readmissions (risk ratio (RR) [95 % confidence interval]: (0.92 [0.88–0.97], p = 0.002). The number of patient contacts was the most prominent effect modifier in meta-regression (p = 0.003) and the effect of medication reviews was approximately twice as strong (15 %) in 11 trials with 2 or more patient contacts (0.85 [0.78–0.92], p < 0.001). No statistically significant reduction in all-cause mortality was observed in a meta-analysis of all 22 trials with data for this outcome (0.95 [0.86–1.04], p = 0.24), including 12,350 participants. The method of mortality assessment was identified as an effect modifier by meta-regression (p = 0.01). A meta-analysis of 10 trials with complete mortality ascertainment via registries or primary care data showed a significantly 19 % reduced mortality (0.81 [0.70–0.94], p < 0.01). In conclusion, medication reviews reduce the risk of hospital readmission and might also reduce all-cause mortality. Comprehensive mortality assessment was essential for successful trials. Clinical guidelines should recommend medication reviews with multiple patient contacts, involving pharmacists, either for repeated medication reviews or to improve adherence.

查看原文本刊更多论文

对住院病人进行用药审查以降低再入院率和死亡率。对研究性试验进行系统回顾、荟萃分析和荟萃回归。

通过药物审查减少可预防的药物相关伤害的努力有所增加，但干预措施往往在临床结果方面产生无效结果。我们对四个数据库进行了系统的文献检索，并通过随机效应荟萃分析，总结了来自随机对照试验（RCTs）的现有证据，比较了住院患者在再入院和全因死亡率方面的药物评价和常规护理。方法学研究差异引起的效应大小差异特别令人感兴趣。对包括12539名受试者在内的所有24项关于医院再入院的试验进行荟萃分析，结果显示再入院率降低了8%（风险比（RR）[95%可信区间]:0.92 [0.88-0.97],p=0.002）。在meta回归中，患者接触者的数量是最显著的影响调节因子（p=0.003），在11项有2名或2名以上患者接触者的试验中，药物评价的影响约为两倍（15%）(0.85 [0.78-0.92],p

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Ageing Research Reviews 医学-老年医学

CiteScore

19.80

自引率

2.30%

发文量

216

审稿时长

55 days

期刊介绍： With the rise in average human life expectancy, the impact of ageing and age-related diseases on our society has become increasingly significant. Ageing research is now a focal point for numerous laboratories, encompassing leaders in genetics, molecular and cellular biology, biochemistry, and behavior. Ageing Research Reviews (ARR) serves as a cornerstone in this field, addressing emerging trends. ARR aims to fill a substantial gap by providing critical reviews and viewpoints on evolving discoveries concerning the mechanisms of ageing and age-related diseases. The rapid progress in understanding the mechanisms controlling cellular proliferation, differentiation, and survival is unveiling new insights into the regulation of ageing. From telomerase to stem cells, and from energy to oxyradical metabolism, we are witnessing an exciting era in the multidisciplinary field of ageing research. The journal explores the cellular and molecular foundations of interventions that extend lifespan, such as caloric restriction. It identifies the underpinnings of manipulations that extend lifespan, shedding light on novel approaches for preventing age-related diseases. ARR publishes articles on focused topics selected from the expansive field of ageing research, with a particular emphasis on the cellular and molecular mechanisms of the aging process. This includes age-related diseases like cancer, cardiovascular disease, diabetes, and neurodegenerative disorders. The journal also covers applications of basic ageing research to lifespan extension and disease prevention, offering a comprehensive platform for advancing our understanding of this critical field.