Impact of Pharmacist-led Discharge Counseling on Hospital Readmission and Emergency Department Visits: A Systematic Review and Meta-analysis

Transitions of care, such as hospital discharge, represent a moment of patient vulnerability that can contribute to the occurrence of medication errors and, consequently, hospital readmissions and mortality.¹ Clinical pharmacists have the potential to optimize the pharmacotherapy, patient safety, and process of care during these transitions, reducing negative outcomes.^2,3

Previous studies have shown that pharmacist interventions at hospital discharge, such as medication review, medication reconciliation, and patient counseling, significantly improve medication adherence and reduce adverse drug reactions, hospital readmission rates, and mortality.^3-8 A recent systematic review, including nine clinical trials, showed that clinical pharmacy services performed in an inpatient setting significantly enhanced quality, safety, and efficiency of care when compared with usual care.⁶ Another study referred to pharmacist-led discharge counseling as a cost-effective intervention that may lead to cost savings of 48% in the healthcare setting.⁹ However, as other studies report no significant impact of pharmacist-led medication counseling at discharge on patient outcomes,^9-13 the current benefit or otherwise of such interventions remains uncertain.

Thus, given the inconsistent conclusions about the real effect of pharmacist interventions and the scarcity of systematic reviews regarding patient counseling, we aimed to synthesize the available evidence on the effect of pharmacist-led discharge counseling on healthcare services utilization (ie, hospital readmission and emergency department visit rates) through a systematic review and meta-analysis.

This systematic review was conducted following the PRISMA statement and Cochrane recommendations^14,15 and was registered in PROSPERO (registration no. CRD42017068444). Screening of titles and abstracts, full-text appraisal, data extraction, and study quality assessment were performed by two reviewers independently, with discrepancies discussed with a third reviewer.

Search and Eligibility Criteria

Systematic searches were conducted in PubMed, Scopus, and DOAJ (Directory of Open Access Journals), without limits for timeframe or language (last updated on November 20, 2018). We performed an additional manual search in the reference lists of the included studies. The following descriptors combined with the Boolean operators “AND” and “OR” were used: “discharge,” “counseling,” and “pharmacist.” The full search strategies are outlined in the Supplemental Material.

We included randomized, controlled trials (RCTs) that compared the intervention of pharmacist-led discharge medication counseling versus usual care. Usual care was defined as patients who received the usual treatment in regular practice. The outcomes of interest were the numbers of hospital readmissions and emergency department visits. Patients of any clinical condition, gender, or age were included. The following exclusion criteria were applied: (1) discharge counseling performed by another healthcare professional or a multidisciplinary team, (2) comparison between pharmacist-led discharge counseling and another healthcare professional’s intervention, (3) studies with a control group also receiving discharge counseling by a pharmacist, (4) study designs other than RCTs, (5) studies that reported other pharmacist interventions, but not discharge counseling, (6) counseling not performed at discharge, and (7) studies not reporting the outcomes of interest.