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Medication review in hospitalised patients to reduce morbidity and mortality

  1. Mikkel Christensen1,*,
  2. Andreas Lundh2

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 10 AUG 2011

DOI: 10.1002/14651858.CD008986.pub2

How to Cite

Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008986. DOI: 10.1002/14651858.CD008986.pub2.

Author Information

  1. 1

    Bispebjerg Hospital, Department of Clinical Pharmacology, Copenhagen, Denmark

  2. 2

    Rigshospitalet, The Nordic Cochrane Centre, Copenhagen, Denmark

*Mikkel Christensen, Department of Clinical Pharmacology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark.

Publication History

  1. Publication Status: New
  2. Published Online: 28 FEB 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Gallagher 2011 {published data only (unpublished sought but not used)}
  • Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clinical Pharmacology and Therapeutics 2011;89(6):845-54. [PUBMED: 21508941]
Gillespie 2009 {published and unpublished data}
  • Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Archives of Internal Medicine 2009;169(9):894-900. [PUBMED: 19433702]
Lisby 2010 {published and unpublished data}
  • Lisby M, Thomsen A, Nielsen LP, Lyhne NM, Breum-Leer C, Fredberg U, et al. The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. Basic and Clinical Pharmacology and Toxicology 2010;106(5):422-7. [PUBMED: 20059474]
Lisby 2011 {unpublished data only}
  • Lisby M, Bonnerup DK, Brock B, Gregersen PA, Jensen J, Rungby J, et al. Systematic medication review and clinically health-related outcome in elderly patients admitted acutely to an orthopedic ward: a randomised controlled study. Clinically Important Medication Errors [PhD Thesis by Marianne Lisby]. Aarhus, Denmark: Faculty of Health Sciences. Aarhus University, 2011:3-33.
Schnipper 2006 {published data only (unpublished sought but not used)}
  • Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counselling in preventing adverse drug events after hospitalization. Archives of Internal Medicine 2006;166(5):565-71. [PUBMED: 16534045]

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
[no author] 2001 {published data only}
  • [no author]. Hospital pharmacists and the NSF for CHD. Pharmaceutical Journal 2001;267(7169):518.
Allen 1986 {published data only}
  • Allen CM, Becker PM, McVey LJ, Saltz C, Feussner JR, Cohen HJ. A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. JAMA 1986;255(19):2617-21. [PUBMED: 3517396]
Al Mazroui 2009 {published data only}
Al-Rashed 2002 {published data only}
Bolas 2004 {published data only}
  • Bolas H, Brookes K, Scott M, McElnay J. Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharmacy World and Science 2004;26(2):114-20. [PUBMED: 15085948]
Burleson 2003 {published data only}
  • Burleson BS. Impact of pharmacist-conducted medication histories on number of pharmacist's interventions, drug cost, medication errors, re-admission rates, and mortality during hospitalization of medicine patients. ASHP Midyear Clinical Meeting. 2003; Vol. 38:P-610.
Burnett 2009 {published data only}
  • Burnett KM, Scott MG, Fleming GF, Clark CM, McElnay JC. Effects of an integrated medicines management program on medication appropriateness in hospitalized patients. American Journal of Health-System Pharmacy 2009;66(9):854-9.
Cardinale 1993 {published data only}
  • Cardinale V. Clinical R.Ph.s in a team prove to be cost-effective. Drug Topics 1993;Jan Suppl:1.
Ciechanover 1987 {published data only}
  • Ciechanover M, Kohn D. A drug-reduction trial in elderly patients. Harefuah 1987;112(11):543-5.
Crotty 2004 {published data only}
  • Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. American Journal of Geriatric Pharmacotherapy 2004;2(4):257-64. [PUBMED: 15903284]
Gattis 1999 {published data only}
  • Gattis WA, Hasselblad V, Whellan DJ, O'Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Archives of Internal Medicine 1999;159(16):1939-45. [PUBMED: 10493325]
Hellstrom 2011 {published data only}
  • Hellstrom LM, Bondesson A, Hoglund P, Midlov P, Holmdahl L, Rickhag E, et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. European Journal of Clinical Pharmacology 2011;67(7):741-52. [PUBMED: 21318595]
Kelly 2011 {published data only}
  • Kelly DM, Frick EM, Hale LS. How the medication review can help to reduce risk of falls in older patients. JAAPA 2011;24(4):30-4, 55. [PUBMED: 21534380]
Koehler 2009 {published data only}
Lipton 1992 {published data only}
  • Lipton HL, Bero LA, Bird JA, McPhee SJ. The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial. Medical Care 1992;30(7):646-58. [PUBMED: 1614233]
McMullin 1999 {published data only}
  • McMullin ST, Hennenfent JA, Ritchie DJ, Huey WY, Lonergan TP, Schaiff RA, et al. A prospective, randomized trial to assess the cost impact of pharmacist-initiated interventions. Archives of Internal Medicine 1999;159(19):2306-9. [PUBMED: 10547170]
Naughton 1994 {published data only}
  • Naughton BJ, Moran MB, Feinglass J, Falconer J, Williams ME. Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial. Journal of the American Geriatrics Society 1994;42(10):1045-9. [PUBMED: 7930327]
Pope 2011 {published data only}
  • Pope G, Wall N, Peters CM, O'Connor M, Saunders J, O'Sullivan C, et al. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients. Age and Ageing 2011;40(3):307–12. [PUBMED: 20817937]
Rainville 1999 {published data only}
  • Rainville EC. Impact of pharmacist interventions on hospital readmissions for heart failure. American Journal of Health-System Pharmacy 1999;56(13):1339-42. [PUBMED: 10683133]
Saltvedt 2005 {published data only}
  • Saltvedt I, Spigset O, Ruths S, Fayers P, Kaasa S, Sletvold O. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. European Journal of Clinical Pharmacology 2005;61(12):921-8. [PUBMED: 16307267]
Schmader 1997 {published data only}
  • Schmader KE, Hanlon JT, Landsman PB, Samsa GP, Lewis IK, Weinberger M. Inappropriate prescribing and health outcomes in elderly veteran outpatients. The Annals of Pharmacotherapy 1997;31(5):529-33. [PUBMED: 9161643]
Schmader 2004 {published data only}
  • Schmader KE, Hanlon JT, Pieper CF, Sloane R, Ruby CM, Twersky J, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. American Journal of Medicine 2004;116(6):394-401. [PUBMED: 15006588]
Scullin 2007 {published data only}
Smith 1996 {published data only}
  • Smith DM, Cox MR, Brizendine EJ, Hui SL, Freedman JA, Martin DK, et al. An intervention on discharge polypharmacy. Journal of the American Geriatrics Society 1996;44(4):416-9. [PUBMED: 8636588]
Spinewine 2007 {published data only (unpublished sought but not used)}
Stowasser 2002 {published data only}
  • Stowasser DA, Collins DM, Stowasser M. A randomised controlled trial of medication liaison services - patient outcomes. Journal of Pharmacy Practice and Research 2002;32:133-40.
Walker 2009 {published data only}
  • Walker PC, Bernstein SJ, Tucker Jones JN, Piersma J, Kim HW, Regal RE, et al. Impact of a pharmacist-facilitated hospital discharge program: A quasi-experimental study. Archives of Internal Medicine 2009;169(21):2003-10. [PUBMED: 19933963]

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
ISRCTN08043800 {unpublished data only}
  • ISRCTN08043800. Pharmaceutical optimization of the medication process during admission to hospital: A multicentre, randomised, controlled trial. (accessed August 2011).
NCT00844025 {unpublished data only}
  • NCT00844025. Pharmaceutical Care and Clinical Outcomes for the Elderly Taking Potentially Inappropriate Medication. (accessed August 2011).

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Aronson 2006
  • Aronson JK. Polypharmacy, appropriate and inappropriate. The British Journal of General Practice 2006; Vol. 56, issue 528:484-5. [PUBMED: 16834872]
Beers 1991
  • Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Archives of Internal Medicine 1991;151(9):1825-32. [PUBMED: 1888249]
Beers 1997
Bregnhøj 2009
  • Bregnhøj L, Thirstrup S, Kristensen MB, Bjerrum L, Sonne J. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care. European Journal of Clinical Pharmacology 2009;65(2):199-207. [PUBMED: 18807252]
Budnitz 2011
  • Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. The New England Journal of Medicine 2011;365(21):2002-12. [PUBMED: 22111719]
CDC 2011
  • Centers for Disease Control and Prevention. Health, United States, 2011. Atlanta: Centers for Disease Control and Prevention, 2012.
Chen 2007
  • Chen TF, de Almeida Neto AC. Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review. Pharmacy World and Science 2007;29(6):574-6. [PUBMED: 17479354]
Christensen 2009
Classen 1997
  • Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997;277(4):301-6. [PUBMED: 9002492]
Deeks 2011
  • Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Ebbesen 2001
  • Ebbesen J, Buajordet I, Erikssen J, Brors O, Hilberg T, Svaar H, et al. Drug-related deaths in a department of internal medicine. Archives of Internal Medicine 2001;161(19):2317-23. [PUBMED: 11606147]
ElDesoky 2007
  • ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. American journal of therapeutics 2007;14(5):488-98. [PUBMED: 17890940]
Epstein 2011
  • Epstein AM, Jha AK, Orav EJ. The relationship between hospital admission rates and rehospitalizations. The New England Journal of Medicine 2011;365(24):2287-95. [PUBMED: 22168643]
European Communities 2006
  • European Communities. Population statistics 2006. (accessed 1 April 2012).
Fick 2003
  • Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of Internal Medicine 2003;163(22):2716-24. [PUBMED: 14662625]
Gallagher 2008a
  • Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics 2008;46(2):72-83. [PUBMED: 18218287]
Gallagher 2008b
  • Gallagher P, O'Mahony D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age and Ageing 2008;37(6):673-9. [PUBMED: 18829684]
Gutierrez 2012
  • Gutierrez J, Ramirez G, Rundek T, Sacco RL. Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis. Archives of Internal Medicine 2012;172(12):909-19. [PUBMED: 22732744]
Hajjar 2007
  • Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy 2007;5(4):345-51. [PUBMED: 18179993]
Hallas 1996
Hanlon 1992
  • Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. Journal of Clinical Epidemiology 1992;45(10):1045-51. [PUBMED: 1474400]
Hasan 2010
  • Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD, et al. Hospital readmission in general medicine patients: a prediction model. Journal of General Internal Medicine 2010;25(3):211-9. [PUBMED: 20013068]
Higgins 2011
  • Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Holland 2008
Joint Commission 2012
  • Joint Commission. Comprehensive Accreditation Manual for Hospitals (CAMH): The Official Handbook. (accessed 19 December 2011).
Jones 1997
Kongkaew 2008
  • Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. The Annals of Pharmacotherapy 2008;42(7):1017-25. [PUBMED: 18594048]
Laroche 2007a
  • Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. European Journal of Clinical Pharmacology 2007;63(8):725-31. [PUBMED: 17554532]
Laroche 2007b
Lefebvre 2011
  • Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Lund 2010
  • Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. Inappropriate prescribing predicts adverse drug events in older adults. The Annals of Pharmacotherapy 2010;44(6):957-63. [PUBMED: 20460558]
Mangoni 2004
Mannheimer 2006
  • Mannheimer B, Ulfvarson J, Eklof S, Bergqvist M, Andersen-Karlsson E, Pettersson H, et al. Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic. European Journal of Clinical Pharmacology 2006;62(12):1075-81. [PUBMED: 17066294]
Marcantonio 1999
  • Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. The American Journal of Medicine 1999;107(1):13-7. [PUBMED: 10403347]
McLeod 1997
  • McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997;156(3):385-91. [PUBMED: 9033421]
Naugler 2000
  • Naugler CT, Brymer C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. The Canadian Journal of Clinical Pharmacology 2000;7(2):103-7. [PUBMED: 10958706]
Nkansah 2010
Page 2010
  • Page RL 2nd, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clinical Interventions in Aging 2010;5:75-87. [PUBMED: 20396637]
Patterson 2012
RevMan 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Rogers 2006
  • Rogers G, Alper E, Brunelle D, Federico F, Fenn CA, Leape LL, et al. Reconciling medications at admission: safe practice recommendations and implementation strategies. Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources 2006;32(1):37-50. [PUBMED: 16514938]
Rothschild 2000
Routledge 2004
Royal 2006
  • Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Quality and Safety in Health Care 2006;15(1):23-31. [PUBMED: 16456206]
Ryan 2009
Salter 2007
  • Salter C, Holland R, Harvey I, Henwood K. "I haven't even phoned my doctor yet." The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative discourse analysis. BMJ 2007;334(7603):1101. [PUBMED: 17449504]
Samsa 1994
  • Samsa GP, Hanlon JT, Schmader KE, Weinberger M, Clipp EC, Uttech KM, et al. A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. Journal of Clinical Epidemiology 1994;47(8):891-6. [PUBMED: 7730892]
Schneeweiss 2002
  • Schneeweiss S, Hasford J, Gottler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. European Journal of Clinical Pharmacology 2002;58(4):285-91. [PUBMED: 12136375]
Spinewine 2007b
  • Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised?. Lancet 2007;370(9582):173-84. [PUBMED: 17630041]
Steurbaut 2010
  • Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, et al. Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. The Annals of Pharmacotherapy 2010;44(10):1596-603. [PUBMED: 20736427]
Wright 2009
Zermansky 2001
  • Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ (Clinical research ed.) 2001;323(7325):1340-3. [PUBMED: 11739221]