Table 1

Characteristics of included studies

Author, YearCountry, SettingStudy designInterventionComparatorTarget of interventionInclusionExclusionComponents of interventionComparatorFollow-up
Relevant outcomesMain results
Anderegg et al 201435USA, single centreBefore–after16641652Admission, dischargeAge 18 years or older, discharge from internal medicine, family medicine, cardiology, or orthopaedic surgery medicalMental illness/alcohol or drug use; discharge to a rehabilitation unit/long-term care facility, readmission for chemotherapy/radiation therapy/rehabilitation therapyAdmission MedRec, Discharge MedRec, patient education, medication calendarControl group (admission MedRec as needed)30 daysReadmission, Readmission and/or ED visit30-day readmission and/or ED visit (general population): NS; 30-day readmission (high-risk): 12.3% (I) vs 17.8% (U), p=0.042
Bolas et al 200450Ireland, single centreRCT8181Inpatient stay, discharge, postdischargeAge 55 years or older, at least 3 regular medicationsTransfer to another hospital or nursing home, unable to communicate, mental illness or alcohol-related admission, follow-up was declinedMedication liaison service (comprehensive medication history, discharge letter faxed to GP and community pharmacist, medicines record sheet, discharge counselling, home visit/telephone call)Standard clinical pharmacy service (not include discharge counselling and liaison service)3 monthReadmission, hospital stay (following readmission)Readmission rate: p>0.05; Length of stay: p>0.05
Eisenhower 201436US, single centreBefore–after2560DischargeAge 65 years or older, with history of COPDLeft the hospital without medical advice, death within 30 days of dischargeMedRec at discharge, Medication reconciliation form, discharge summaryUsual care (pharmacist was not present during baseline data collection)30 daysReadmissionReadmission rate: 16% (I) vs 22.2% (U)
Farris et al 2014 37USA, Single centreRCTMinimal=312
313Admission, inpatient stay, discharge18 years or older, English or Spanish speaker, diagnosis of HPN, hyperlipidaemia, HF, CAD, MI, stroke, TIA, asthma, COPD or receiving oral anticoagulationAdmission to psychiatry, surgery or haematology/oncology service, could not use a telephone, had life expectancy <6 months, had dementia or cognitive impairmentAdmission MedRec, patient education during inpatient stay, discharge counselling, discharge medication list, telephone call, care plan faxed to primary care physician/community pharmacistUsual care (admission MedRec, nurse-led discharge counselling and medication list)90 days ADEs, readmission, ED visit, readmission and/or ED visit16% experienced an AE, Healthcare utilisation at 30 days and 90 days: NS
Gardella et al 201238US, multicentreBefore–after16247335Preadmission to post dischargeNANAPreadmission medication list, patient educationHistorical control group (preadmission medication list gathered by nurse)60 days ADE, ED visits and readmission30-day readmission: 6% (I) vs 13.1% (U) (OR 2.34, 95% CI 1.87 to 2.94, p<0.001); 60-day readmission: 2.7% (I) vs 7.7% (U) (OR 3.02, 95% CI 2.18 to 4.19, p<0.001)
Gillespie et al 200946Sweden, single centreRCT182186Admission, inpatient stay and dischargeAge 80 or olderPrevious admission during the study periodAdmission MedRec, discharge counselling, medication review, faxing discharge summary to primary care physicians, telephone follow-up at 2 monthsUsual care (without pharmacist involvement)12 monthReadmissions, ED visits, mortalityReadmissions: 58.2% (I) vs 59.1% (U) (OR 0.96, 95% CI 0.64 to 1.4); ED visits per patient: 0.35 (I) vs 0.66 (U) (OR 0.53, 95% CI 0.37 to 0.75)
Hawes et al 201439US, single centreRCT2437Discharge and post dischargeHigh-risk patients ( HF, COPD, hyperglycaemic crisis, stroke ,NSTEM, more than 3 hospitalisations in the past 5 years., 8 or more medications on discharge)Age <18 years, inability to communicate in English, unable to follow-up (no transportation and no telephone access), transfer to facilities other than primary care, decisional impairment, incarcerationPost discharge medication reconciliationUsual care (with no pharmacist intervention)30 daysReadmission, ED visit, readmission and /or ED visit ED visit: 0 (I) vs 29.7% (U), p=0.004; Readmission: 0 (I) vs 32.4% (U), p=0.002; Composite of hospitalisation or ED visit: 0 (I) vs 40.5% (C), p<0.001
Hellstrom et al 201147Sweden, single centreBefore–after109101Admission, inpatient stay, dischargeAge 65 years or older, at least one regular medicationStaying during the implementation periodLIMM model, admission and discharge MedRec, medication review and monitoring, quality control of discharge MedRecStandard care (no formal MedRec by clinical pharmacists)3 monthReadmission and ED visit,ADE-related hospital visitED visit and readmission: 45/108 (I) vs 41/100 (U)
Mortality, 3 month: 9/108 (I) vs 9/100 (U)
ADE-related revisit: 6/108 (I) vs 12/100 (U)
Hellstrom et al 201248Sweden, single centreBefore–after12162758Admission, inpatient stayHigh-risk patients (age ≥65 years with any of HF, RF)NAAdmission MedRec, structured medication reviews, follow-up at least two times a weekUsual care (no clinical pharmacists working in the wards)6 monthED visits, hospital admissions and mortalityED visit: 48.8% (I) vs 51.3% (U) (HR 0.95, 95% CI 0.86 to 1.04); All ED visits, hospitalisation or death: 58.9% (I) vs 61.2% (U) (HR 0.96, 95% CI 0.88 to 1.04)
Mortality: 18.2% (I) vs 17.3% (U), p=0.55
Koehler et al 200940US, single centreRCT2021Admission, discharge and post dischargeAge 70 years or older, ≥5 medications, ≥3 chronic comorbid conditions, assisted living, English language, phone contactPrimarily surgical procedure, life expectancy ≤6 months, residence in long-term care facility, refusal to participate, not enrolled within 72 h.Targeted care bundle, medication reconciliation and education, follow-up call, enhanced discharge formUsual care (nurse and care coordination staff providing care)60 daysReadmission and/or ED visits30 days readmission/ED visits: 2/20 (I) vs 8/21 (U), p= 0.03; 60days readmission/ED visits: 6/20 (I) vs 9/21 (U), p= 0.52
Pal et al 201341US, single centreNRCT537192DischargeAge 18 years or older, at least 10 regular medicationsNAPatient counselling, pharmacist medication reconciliation, medication calendarUsual care (without discharge review by pharmacist) 30 daysReadmission30 days readmission: 16.8% (I) vs 26.0% (U), p=0.006
ADE prevented: 52.8%
Schnipper et al 200642US, single centreRCT9284Inpatient stay, discharge, post dischargeDischarge to home, contacted 30 days after discharge, spoke English, cared for primary care physician/internal medicine residentNADischarge medication reconciliation, telephone follow-up, medication review, standard email template, patient counsellingUsual care (medication review by a pharmacist and discharge counselling by a nurse) ADEs-related hospital visit, readmission and/or ED visitPreventable ADE: 1% (I) vs 11% (U), p=0.01; ED visit/readmission: 30% (I) vs 30% (U), p>0.99; preventable medication-related healthcare utilisation: 1% (I) vs 8% (U), p= 0.03
Scullin et al 200749Ireland, multicentreRCT371391Admission, inpatient stay, dischargeAge 65 years or older, at least 4 regular medications, taking antidepressants, previous admission in the past 6 months, taking intravenous antibioticsScheduled admissions and admissions from private nursing homesIntegrated medicines management service admission and discharge MedRec, inpatient medication review and counselling, telephone follow-upUsual care (did not receive integrated medicines management service)12 monthLength of hospital stay, readmissionLoS reduced by 2 days for intervention vs usual care, p=0.003
Readmissions per patient: 0.8 (I) vs 1 (U)
Stowasser et al 200251Australia, multicentreRCT113127Admission, dischargeReturn to the community following dischargeOutpatients, discharge to hostel or nursing home, previous enrolment, unable to provide consent and follow-upMedication liaison service—medication history confirmation with community healthcare professionals (telephone, faxing), 30 days post follow-upUsual care (no medication liaison service)30 daysMortality, readmission, ED visitMortality, 30 days: 2/113 (I) vs 3/127 (U): NS
Readmissions: 12/113 (I) vs 17/127 (U)
ED visit per patient: 7.54 (I) vs 9.94 (U)
Walker et al 200943US, single centreNRCT138366Discharge, post dischargeAge 18 years or older, 5 or more regular medications, receiving 1 or more targeted medications, having 2 or more therapy modification, unable to manage their medication, receiving a medication requiring therapeutic drug monitoringNon-English speaking, stay of 21 days or longerPatient interviews, follow-up plan, medication counselling, telephone follow-upUsual care (nurse-led service)30 daysReadmission, ED visit, readmission and/or ED visitReadmission, 14 days: 12.6% (I) vs 11.5% (U), p=0.65; Readmission, 30 days: 22.1% (I) vs 18.0% (U), p=0.17; Readmissions and/or ED visits: 27.4% (I) vs 25.7% (U), p= 0.61
Warden et al 201444US, single centreBefore–after35115Admission, inpatient stay, dischargeAge 18–85 years, systolic dysfunction (EF ≤40)Diastolic dysfunction, valve replacement/left ventricular assist deviceMedication reconciliation (admission and discharge), discharge instructions, telephone follow-upHistorical control group (physicians—admission MedRec; nurses- discharge counselling)30 daysReadmissionAll cause readmission, 30-day :17% (I) vs 38% (U) (RR 0.45, 95% CI 0.21 to 0.96, p=0.02), 30 days HF-related readmission: 6%(I) vs 18% (U) (RR 0.31, 95% CI 0.08 to 1.27, p=0.11)
Wilkinson et al 201145US, single centreNRCT229440DischargeAge 18 years or older, English speaking, patients with depression, receiving high-risk medications and polypharmacy, poor health literacy, having an absence of social support, prior hospitalisation within the past 6 monthsRefusal of pharmacist education, transfer to a skilled nursing facility, or discharge when the pharmacist was not availableMedication history at admission, during hospitalisation and discharge, patient education on dischargeControl group (pharmacists not provide medication counselling at discharge)30 daysReadmissionReadmission rate: 15.7% (I) vs 21.6% (U) (RR 0.728, 95% CI 0.514 to 1.032, p =0.04)
  • ADE, adverse drug event; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; D, days; ED, emergency department; EF, ejection fraction; GP, general practitioner; HF, heart failure; HPN, hypertension; I, intervention; IV, intravenous; LIMM, Lund Integrated Medicines Management; LoS, length of stay; MedRec, medication reconciliation; MI, myocardial infarction; NA, not available; NS, non-significant; NSEMI, non-ST segment elevation myocardial infarction; RCT, randomised controlled trials; RF, renal failure; RR, relative risk; TIA, transit ischaemic attack; U, usual care.