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Medication Counselling in Older Patients Prior to Hospital Discharge: A Systematic Review

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Abstract

Background

Older patients are regularly exposed to multiple medication changes during a hospital stay and are more likely to experience problems understanding these changes. Medication counselling is often proposed as an important component of seamless care to ensure appropriate medication use after hospital discharge.

Objectives

The purpose of this systematic review was to describe the components of medication counselling in older patients (aged ≥ 65 years) prior to hospital discharge and to review the effectiveness of such counselling on reported clinical outcomes.

Methods

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology (PROSPERO CRD42019116036), a systematic search of MEDLINE, EMBASE and CINAHL was conducted. The QualSyst Assessment Tool was used to assess bias. The impact of medication counselling on different outcomes was described and stratified by intervention content.

Results

Twenty-nine studies were included. Fifteen different components of medication counselling were identified. Discussing the dose and dosage of patients’ medications (19/29; 65.5%), providing a paper-based medication list (19/29; 65.5%) and explaining the indications of the prescribed medications (17/29; 58.6%) were the most frequently encountered components during the counselling session. Twelve different clinical outcomes were investigated in the 29 studies. A positive effect of medication counselling on medication adherence and medication knowledge was found more frequently, compared to its impact on hard outcomes such as hospital readmissions and mortality. Yet, evidence remains inconclusive regarding clinical benefit, owing to study design heterogeneity and different intervention components. Statistically significant results were more frequently observed when counselling was provided as part of a comprehensive intervention before discharge.

Conclusions

Substantial heterogeneity between the included studies was found for the components of medication counselling and the reported outcomes. Study findings suggest that medication counselling should be part of multifaceted interventions, but the evidence concerning clinical outcomes remains inconclusive.

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Acknowledgements

The authors thank the executive board of the Belgian Society for Gerontology and Geriatrics (BSGG), which includes the following members: Jean-Pierre Baeyens, Ivan Bautmans, Nicolas Berg, Katrien Cobbaert, Isabelle de Brauwer, Sandra de Breucker, Anne Marie de Cock, Marie de Saint Hubert, Johan Flamaing, Sophie Gillain, Tony Mets, Nele Van Den Noortgate.

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Authors and Affiliations

  1. Department of Pharmacy, Ghent University Hospital, Ghent, Belgium

    Andreas Capiau & Annemie Somers

  2. Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium

    Andreas Capiau, Katrien Foubert & Annemie Somers

  3. Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium

    Lorenz Van der Linden, Karolien Walgraeve & Julie Hias

  4. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

    Lorenz Van der Linden

  5. Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Brussels, Belgium

    Anne Spinewine

  6. Department of Pharmacy, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium

    Anne Spinewine & Anne-Laure Sennesael

  7. Department of Geriatrics, Ghent University Hospital, Ghent, Belgium

    Mirko Petrovic

  8. Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Mirko Petrovic

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the Belgian Society for Gerontology and Geriatrics (BSGG)

Contributions

All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: AC, AS and MP designed the study; AC developed the search strategy and performed the literature search; all authors conducted the review; AC, AS and MP performed the data extraction and quality assessment; AC wrote the first draft of the manuscript and all authors revised the manuscript, approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Andreas Capiau.

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Funding

This study was funded by the Belgian Society for Gerontology and Geriatrics (BSGG).

Conflict of interest

Andreas Capiau, Katrien Foubert, Lorenz Van der Linden, Karolien Walgraeve, Julie Hias, Anne Spinewine, Anne-Laure Sennesael, Mirko Petrovic and Annemie Somers have no conflicts of interest that are directly relevant to the content of this article.

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The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Capiau, A., Foubert, K., Van der Linden, L. et al. Medication Counselling in Older Patients Prior to Hospital Discharge: A Systematic Review. Drugs Aging 37, 635–655 (2020). https://doi.org/10.1007/s40266-020-00780-z

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