Impact of pharmacist and physician collaborations in primary care on reducing readmission to hospital: A systematic review and meta-analysis.

Abstract

BACKGROUND\nReadmissions to hospital due to medication-related problems are common and may be preventable. Pharmacists act to optimise use of medicines during care transitions from hospital to community.\n\n\nOBJECTIVE\nTo assess the impact of pharmacist-led interventions, which include communication with a primary care physician (PCP) on reducing hospital readmissions.\n\n\nMETHODS\nPubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science were searched for articles published from inception to March 2021 that described interventions involving a pharmacist interacting with a PCP in regards to medication management of patients recently discharged from hospital. The primary outcome was effect on all-cause readmission expressed as Mantel-Haenszel risk ratio (RR) derived from applying a random effects model to pooled data. Sensitivity analysis was also conducted to investigate differences between randomised controlled trials (RCTs) and non-RCTs. The GRADE system was applied in rating the quality of evidence and certainty in the estimates of effect.\n\n\nRESULTS\nIn total, 37 studies were included (16 RCTs and 29 non-RCTs). Compared to control patients, the proportion of intervention patients readmitted at least once was significantly reduced by 13% (RR\xa0=\xa00.87, CI:0.79-0.97, p\xa0=\xa00.01; low to very low certainty of evidence) over follow-up periods of variable duration in all studies combined, and by 22% (RR\xa0=\xa00.78, CI:0.67-0.92; low certainty of evidence) at 30 day follow-up across studies reporting this time point. Analysis of data from RCTs only showed no significant reduction in readmissions (RR\xa0=\xa00.92, CI:0.80-1.06; low certainty of evidence).\n\n\nCONCLUSIONS\nThe totality of evidence suggests pharmacist-led interventions with PCP communication are effective in reducing readmissions, especially at 30 days follow-up. Future studies need to adopt more rigorous study designs and apply well-defined patient eligibility criteria.