1. Int J Qual Health Care. 2013 Sep;25(4):403-17. doi: 10.1093/intqhc/mzt032. Epub
2013 May 2.

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

Spinewine A, Claeys C, Foulon V, Chevalier P.

Clinical Pharmacy Research Group, Université catholique de Louvain, Louvain Drug 
Research Institute, Av E Mounier, 73, B1.72.02-1200 Brussels, Belgium; Pharmacy
Department, CHU Mont-Godinne, Av Dr G Therasse, 1-5530 Yvoir, Belgium.
anne.spinewine@uclouvain.be.

PURPOSE: /st> 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: /st> MEDLINE, EMBASE, CINAHL, IPA and the Cochrane Database of
Systematic Reviews from 1995 through December 2010.
STUDY SELECTION: /st> Controlled, parallel-group trials. Data extraction Data
were extracted by one researcher and checked by another. Both reviewers
independently assessed the study quality.
RESULTS: /st> 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: /st> 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.

PMID: 23639854  [PubMed - in process]