title: The effect of early in-hospital medication review on health outcomes: a systematic review.
abstract: OBJECTIVE
  Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data.
  
  
  METHODS
  We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis.
  
  
  RESULTS
  We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] -0.04 days, 95% confidence interval [CI] -1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design.
  
  
  CONCLUSIONS
  Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes.
authors.affiliation: Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.|Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.
authors.forename: Corinne M
authors.initials: CM
authors.lastname: Hohl
authors.affiliation: Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.|Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.
authors.forename: Maeve E
authors.initials: ME
authors.lastname: Wickham
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.|School of Population and Public Health, The University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9.
authors.forename: Boris
authors.initials: B
authors.lastname: Sobolev
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Ave., E-Main Room EM-206, Box 227, Ottawa, Ontario, K1Y 4E9.|Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, K1Y 4E9.
authors.forename: Jeff J
authors.initials: JJ
authors.lastname: Perry
authors.affiliation: Departments of Emergency Medicine, and of Biomedical & Molecular Sciences, Queen's University, c/o 76 Stuart Street, Kingston, ON, K7L 2 V7.
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
authors.affiliation: Department of Family Medicine, University of Alberta, 8215-112 Street NW, Room 1706 College Plaza, Edmonton, Alberta.
authors.forename: Scott
authors.initials: S
authors.lastname: Garrison
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, University of Calgary, Rockyview General Hospital, HCAC building, 7007 14th St. SW, Calgary, AB, T2V 1P9.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.|Department of Statistics, The University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
authors.forename: Penny
authors.initials: P
authors.lastname: Brasher
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Doyle-Waters
authors.affiliation: Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.
authors.forename: Baljeet
authors.initials: B
authors.lastname: Brar
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 1G1.42 Walter Mackenzie Building, Edmonton, AB, T6G 2B7.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: School of Health Policy and Management, York University, 4700 Keele St., Toronto, ON, M3J 1P3.|Emergency Department, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4.
authors.forename: Joel
authors.initials: J
authors.lastname: Lexchin
authors.affiliation: Public Health Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008510:Medication Systems, Hospital
keywords: adverse drug events; clinical pharmacist; clinical pharmacy; drug related problems; medication history; medication review