Medication review in hospitalised patients to reduce morbidity and mortality

Medication review appears to reduce emergency department contacts but appears not to reduce mortality or hospital readmissions in elderly patients.

Summary

A Cochrane review included 10 studies with a total of 3575 subjects. Participants were elderly with a mean age around 80 years in all trials except three. All were hospital patients. The proportion of women among included participants ranged from 53% to 71%, and the mean number of drugs per participant ranged from 7 to 11. Follow-up ranged from 30 days to one year. Nine trials provided mortality data (466 events, n=3218), with a risk ratio of 1.02 (95% CI 0.87 to 1.19). Seven trials provided hospital readmission data (1043 events, n=2843) with a risk ratio of 0.95 (95% CI 0.87 to 1.04). Four trials provided emergency department contact data (244 events, n=1442) with a risk ratio of 0.73 (95% CI 0.52 to 1.03). The estimated reduction in emergency department contacts of 27% (with a CI ranging from 48% reduction to 3% increase in contacts) corresponds to a NNT for an additional beneficial outcome of 37 for a low-risk population and 12 for a high-risk population over one year. Subgroup and sensitivity analyses did not significantly alter the results.

Comment: The quality of the evidence is downgraded by indirectness (short follow-up time, only hospital patients included).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2016;2():CD008986.