Pierre Chevalier

Approaches for improving continuity of care in medication management: a systematic review

PURPOSE Medication-related problems frequently occur during transitions and lead to patient harm, increased use of healthcare resources and increased costs. The objective of this systematic review is to synthesize the impact of approaches to optimize the continuity of care in medication management upon hospital admission and/or discharge. DATA SOURCES MEDLINE, EMBASE, CINAHL, IPA and the Cochrane Database of Systematic Reviews from 1995 through December 2010. STUDY SELECTION Controlled, parallel-group trials. Data extraction Data were extracted by one researcher and checked by another. Both reviewers independently assessed the study quality. RESULTS Thirty studies met the inclusion criteria, but only 14 reached the predefined minimum quality score. Most studies focused on discharge and targeted the patients, sometimes together with primary care providers. The majority of studies found improvements in process measures. Patient education and counseling provided upon discharge and reinforced after discharge, sometimes together with improved communication with healthcare professionals, was shown to reduce the risk of adverse drug events and hospital re-admissions in some studies, but not all. Heterogeneity in study population as well as in intervention and outcome reporting precluded meta-analysis and limited interpretation. Most studies had important methodological limitations and were underpowered to show significant benefits on clinical outcomes. CONCLUSIONS The evidence for an impact of approaches on optimization of continuity of care in medication management remains limited. Further research should better target high-risk populations, use multicentered designs and have adequate sample size to evaluate the impact on process measures, clinical outcomes and cost-effectiveness.