Effectiveness of interventions to improve patient transitions from Secondary to Primary Care- A Systematic Review and Network Meta-Analysis of randomised controlled trials.

The Problem:

Patient discharge from secondary care to primary care or social care is a crucial transitional point in the patient journey. It is estimated that one in 5 patients experience sub-optimal care at discharge worldwide resulting in avoidable readmissions or patient harm. Several international trials have tested interventions to improve the safety and efficiency of patient transition from hospitals to primary care or social care settings. However, it is unclear whether these interventions are effective, and which patient groups are most likely to benefit by which types of interventions.

Approach:

A systematic review with network meta-analysis is being performed. Several databases were searched from inception to March 2020 including Medline, Embase, Cinahl PsychINFO and Central. The primary outcome is 30-day patient readmission rates. Following title/abstract and full-text screening, 103 randomised control trials which tested different transitional interventions from secondary to primary/social care were identified. Interventions were mainly classified into four types,  communication, medication, lifestyle and multicomponent.

The Learning:

Via Network Meta-analysis we can see which interventions are effective at reducing readmissions as opposed to usual care. We can also compare the interventions against each other to see if a certain intervention category is more effective. Preliminary results suggest that transitional interventions are moderately effective in reducing hospital admissions compared to usual care. Additional analyses are  ongoing and directed towards looking at comparisons between different types of interventions and different patient populations within each intervention to see if the observed benefits are dependent upon specific intervention contents and patient characteristics.

Why it matters:

The results of this study can be used to inform healthcare professionals and policy makers on which interventions work best at reducing hospital readmissions and which types of interventions should be prioritised during health care transitions for different patient groups. 

Presenting author: Oliver Wright,

Final year Medical Student Manchester University,

Oliver.wright-7@student.manchester.ac.uk
 

Co-authors: Tyler, N1; Hodkinson, A1; Daker-White, G1; Keyworth, C1; Hall, A1; Pascal Jones, P2; Wright,O2; Blakeman, T1, Panagioti, M1

1) NIHR School for Primary Care Research Manchester

2)Manchester Medical School

natasha.tyler@manchester.ac.uk, alex.hall@manchester.ac.uk, gavin.daker-white@manchester.ac.uk, t.m.blakeman@manchester.ac.uk,  maria.panagioti@manchester.ac.uk,