113 Pharmacist Interventions at Discharge and the Quality of Older Patients' Care: A Systematic Review

Background Discharge and transfer between healthcare facilities put older adults at risk of medication-related problems and early readmission. This review examined the evidence for pharmacist interventions at discharge and patients’ care quality. Methods Eight databases were searched systematically from inception to date, using the appropriate search strategy for each. A search for grey literature was conducted on eight further websites. No filters (e.g. language/dates) were applied. Only prospective randomized/quasi-randomized controlled studies involving patients > 65 years of both genders, discharged alive from hospital, were included. The criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions formed the basis of the assessment, conducted using RevMan 5.3. Results 9738 articles were obtained: 8120 unique articles after duplicate removal. Following screening, 12 studies were identified for inclusion. Interventions comprised follow up, medication review and patient counselling at discharge. Of these, 10 were delivered by pharmacists alone, while the remainder were delivered by pharmacists within a multidisciplinary team. Outcome measures included readmission rates, length of stay, medication adherence and care quality. Nine studies showed significant improvements over standard care, e.g. a decrease in hospital admissions (0.68 OR, p=0.002), improved compliance (P<0.001) and a 47% reduction in emergency department visits (95% CI, 0.37-0.75). However, three studies did not report positive results: Two reported non-significant improvement but the third reported poorer readmission rates. Risk of bias was low but the high baseline standard of care reduced the scope for improvement in two of these studies. Conclusion The review summarizes pharmacist interventions’ efficacy and their effect on care quality indicators where possible. The majority of interventions at discharge significantly enhanced patients’ care quality. The findings should prove valuable to decision-makers when planning or improving discharge and post-discharge services.