The combination of self-management activities, telephone follow-ups and medicine reconciliation are most likely to reduce readmissions to hospital in older patients.
This is the conclusion of a meta-analysis from a group of researchers from the Universities of Bradford and Leeds in the UK.
For the analysis, the team looked at studies in which the interventions were either delivered in hospital prior to discharge or within one month of discharge and that included patients 65 years of age and older. The main outcome of interest was a reduction in hospital readmission rates. In total, 24 studies conducted in 12 countries and thus covering a range of public and privately funded healthcare systems and with 17,664 participants were analysed. When stratified by the intervention component, each of the following were associated with a statistically significant reduction in hospital readmission. Self-management activities (relative risk, RR = 0.81, 95% CI 0.74–0.89), telephone follow-up (RR = 0.84, 95% CI 0.73–0.97) and medication reconciliation (RR = 0.88, 95% CI 0.81–0.96). However, studies were highly heterogenous and it was therefore difficult to attribute the success to individual components within bundles.
Nevertheless, the authors concluded that interventions which included these three components were most likely to be effective although it remained unclear how best to engage with patients or carers in order to provide this support.
Tomlinson J et al. Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age Ageing 2020 Jul 1;49(4):558–69.