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    Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

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    Silcock_et_al_Age_and_Ageing.pdf (727.7Kb)
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    Publication date
    2020-07
    Author
    Tomlinson, Justine
    Cheong, V-L.
    Fylan, Beth
    Silcock, Jonathan
    Smith, H.
    Karban, Kate
    Blenkinsopp, Alison
    Keyword
    Medication management
    Systematic review
    Continuity of care
    Hospital discharge
    Older people
    Rights
    © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Peer-Reviewed
    Yes
    
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    Abstract
    Background: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.
    URI
    http://hdl.handle.net/10454/17703
    Version
    Published version
    Citation
    Tomlinson J, Cheong V-L, Fylan B et al (2020) Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age and Ageing. 49(4): 558-569.
    Link to publisher’s version
    https://doi.org/10.1093/ageing/afaa002
    Type
    Article
    Collections
    Life Sciences Publications

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