Claus 2014¹³

RCT

Surgical ICU admissions (n=69) within a university hospital in Belgium.

Inclusion - over 16 years of age, length of stay greater than 48 hours.

Exclusion - none stated.

No pharmacist screening or discharge services.

Patients crossed to intervention group if the pharmacist was asked by the caregiver to give advice.

Pharmacist saw all patients, but recommendations were not passed onto the caregiver in the control group.

Intervention conducted by 1 of 2 clinical pharmacists.

Iowa Continuity of Care Study trial: Farris 2014¹⁸

(Farley 2014¹⁷)

RCT

Pharmacy case manager. Duties included medication reconciliation, ward visits and discharge service.

Versus

Nurse based medication reconciliation and discharge service.

General medicine, family medicine, cardiology or orthopaedic admissions (n=631) within an academic tertiary care hospital in the USA.

Inclusion - patients with certain disease classifications: hypertension, hyperlipidaemia, heart failure, coronary artery disease, myocardial infarction, stroke, transient ischemic attack, asthma, chronic obstructive pulmonary disease or receiving oral anticoagulation.

Preventable adverse drug events in-hospital; post-discharge (90 days) hospital

Readmission at 30 days; Admission at 90 days

Medication appropriatene ss index (MAI) at discharge; 30 days; 90 days.

Farley 2010 indicates that the initial medication reconciliation is normally undertaken by a nurse in the control group.

Unclear number of pharmacists involved.

Data was extracted from Farris 2014 MAI is based on 6 criteria.

Gillespie 2009²¹

RCT

Pharmacist present on the ward. Duties included taking part in the rounding team, documenting medication history, and discharge counselling.

Versus

No pharmacist involvement in the healthcare team at the ward level.

Patients (n=400) admitted to the 2 acute internal study wards at a University teaching hospital in Sweden.

Inclusion - 80 years of age.

Exclusion - previously been admitted to the study wards during the study period or had scheduled admissions.

Overall survival at 12 months, reported as hazard ratio.

Admission at 12 months

A follow-up telephone call to patients 2 months after discharge was conducted in the intervention group

Admission and discharge documentation filled by physicians and nurses in comparison group Intervention conducted by 1 of 3 clinical pharmacists.

During follow-up period intervention patients received enhanced care again, but were excluded if admitted during the intervention period.

Kucukarslan 2003³⁵

Quasi-RCT

Pharmacist present on the ward. Duties included taking part in the rounding team, documenting medication history, and discharge counselling.

Versus

Standard care from 1 pharmacist (implication in paper that this is not ward-based).

All patients (n=165) admitted to 1 of the 2 internal medicine study wards within a tertiary care hospital in the USA.

Inclusion - admitted to the internal medicine service and remained in the same patient care unit until discharge.

Exclusion – none given.

Avoidable adverse drug events until discharge.

Length of stay in-hospital (reported as mean difference).

Re-admission (unclear follow-up time, reported as percentage reduction).

Admitting process was based on the availability of beds and physician service.

Pharmacist on the ward Mon-Fri. Intervention conducted by 1 of 2 clinical pharmacists.

Usual care involved identification of medication problems retrospectively through records

Shen 2011⁵⁸

China

RCT

Clinical pharmacist part of the treating team – communicated any potentially inappropriate antibiotic use (indication, choice, dosage, dosing schedule, duration, conversion) with the physician to discuss and make recommendations.

Versus.

Standard treatment strategies performed by the physicians and nurses without pharmacist involvement.

n=354 inpatients in 2 respiratory wards diagnosed with respiratory tract infections.

Exclusion criteria: transferred from other medical departments; transferred to other medical departments for further treatment; already received antibiotics before admission; did not receive antibiotics during hospitalisation.

Scullin 2007⁵⁷

RCT

Pharmacist present on the ward. Duties included admission services, in-patient monitoring, and discharge services

Versus

Traditional clinical pharmacy services (no further details given).

Admitted patients (n=762) to the 4 medical study wards within 3 general hospitals in northern Ireland.

One of the following criteria: taking at least 4 regular medication, were taking a high risk drug(s), were taking antidepressants and were 65 years old or older, had a hospital admission within the last 6 months, prescribed antibiotics on day 1 of admission.

Exclusion - scheduled admissions and patients admitted from private nursing homes.

Admission at 12 months.

Mortality at 12 months.

Length of stay.

Spinewine 2007⁵⁹

RCT

Pharmacist present on the ward. Duties included taking part in the rounding team, documenting medication history, and discharge counselling.

Versus

Usual care (no details of any clinical pharmacist involvement).

All eligible patients (n=186) admitted to the Geriatric Evaluation and Management (GEM) unit within a university teaching hospital in Belgium.

GEM unit accepted patients over 70 years of age.

Rate of death at 1 year follow-up.

Satisfaction with information received.

Admission at 12 months.

Medical appropriateness index.

Pharmacist was on the unit for 4 days a week.

Intervention conducted by a single clinical pharmacist.

GEM team consisted of 2 geriatricians, 2 residents, nurses, 2 physiotherapists, a social worker, a psychologist, and an occupational therapist.

MAI is based on 10 criteria (not defined).

Zhao 2015⁷⁰ & Zhao 2015B⁶⁹

RCT

Interventions by clinical pharmacists including individual drug regimens, attending daily medical rounds, advice to physicians, education of medical staff, patient education on lifestyle changes, psychological interventions such as stress reduction, medication counselling at discharge, monthly follow up telephone calls post-discharge.

Versus

Conventional medical treatment without pharmacist participation.

n=90 patients admitted to the cardiology ward in a hospital in China.

Inclusion criteria: diagnosis of CHD by physician, accepted ≥4 kinds of drugs, ≥18 years, primary high school education, able to complete the study, available for telephone follow up.

Exclusion criteria: pregnant/lactating women, patients enrolled in other studies, severe co-morbidities, family history of psychosis, and barriers to communication.

Avoidable adverse events (adverse drug reactions).

Patient and/or carer satisfaction.