***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND OBJECTIVES CKD is characterized by remarkably high hospitalization and readmission rates . Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS The CKD Medication Intervention Trial was a single-blind ( investigators ) , r and omized clinical trial conducted at Providence Health Care in Spokane , Washington . Patients with CKD stages 3 - 5 not treated by dialysis who were hospitalized for acute illness were recruited . The intervention was design ed to improve posthospitalization care by medication therapy management . A pharmacist delivered the intervention as a single home visit within 7 days of discharge . The intervention included these fundamental elements : comprehensive medication review , medication action plan , and a personal medication list . The primary outcome was a composite of acute care utilization ( hospital readmissions and emergency department and urgent care visits ) for 90 days after hospitalization . RESULTS Baseline characteristics of participants ( n=141 ) included the following : age , 69±11 ( mean±SD ) years old ; women , 48 % ( 67 of 141 ) ; diabetes , 56 % ( 79 of 141 ) ; hypertension , 83 % ( 117 of 141 ) ; eGFR , 41±14 ml/min per 1.73 m2 ( serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation ) ; and urine albumin-to-creatinine ratio median , 43 mg/g ( interquartile range , 8 - 528 ) creatinine . The most common primary diagnoses for hospitalization were the following : cardiovascular events , 36 % ( 51 of 141 ) ; infections , 18 % ( 26 of 141 ) ; and kidney diseases , 12 % ( 17 of 141 ) . The primary outcome occurred in 32 of 72 ( 44 % ) of the medication intervention group and 28 of 69 ( 41 % ) of those in usual care ( log rank P=0.72 ) . For only hospital readmission , the rate was 19 of 72 ( 26 % ) in the medication intervention group and 18 of 69 ( 26 % ) in the usual care group ( log rank P=0.95 ) . There was no between-group difference in achievement of guideline -based goals for use of renin-angiotensin system inhibition or for BP , hemoglobin , phosphorus , or parathyroid hormone . CONCLUSIONS Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home Introduction Older people experience greater morbidity with a corresponding increase in medication use result ing in a potentially higher risk of adverse drug reactions ( ADRs ) . The aim of this study is to determine the prevalence and characteristics of ADR-related hospital admissions among older patients ( ≥65 years ) and their associated health and cost outcomes . Methods and analysis The proposed study will include a cross-sectional study of ADR prevalence in all patients aged ≥65 years admitted acutely to a large tertiary referral hospital in Irel and over a 9-month period ( 2016–2017 ) and a prospect i ve cohort study of patient-reported health outcomes and costs associated with ADR-related hospital admissions . All acute medical admissions will be screened for a suspected ADR-related hospital admission . A number of vali date d algorithms will be applied to assess the type , causative medications , preventability and severity of each ADR . ADRs will be determined , using a consensus method , by an expert panel . Patients who provide consent will be followed up 3 months post-discharge to establish patient-reported health outcomes ( health service use , health-related quality of life , adherence ) and costs associated with ADR-related hospital admissions . A r and om sample of patients admitted to hospital without a suspected ADR will be invited to take part in the study as a control group . Ethics and dissemination Ethical approval was obtained from Beaumont Hospital Ethics Committee . Findings will be disseminated through presentations and peer- review ed publications Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Lack of information about medications coupled with high rates of utilization complicates compliance with medication regimens and increases the risk of adverse effects among older adults . We undertook a study of the efficacy of community-based interventions by pharmacists in a r and omly-allocated one-half of a sample of 284 older adults considered to be at high risk for medication-related problems .  Information and attitudes towards prescription and over-the-counter medications did not differ significantly between the intervention and comparison groups , either before or after the pharmacist interventions . However , visits to physicians were significantly less in the intervention group , suggesting an important if unexpected impact on health-related behavior Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients . Design R and omised controlled trial . Setting Home based intervention in heart failure patients . Participants 293 patients diagnosed with heart failure were included ( 149 intervention , 144 control ) after an emergency admission . Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge . Pharmacists review ed drugs and gave symptom self management and lifestyle advice . Controls received usual care . Main outcome measures The primary outcome was total hospital readmissions at six months . Secondary outcomes included mortality and quality of life ( Minnesota living with heart failure question naire and EQ-5D ) . Results Primary outcome data were available for 291 participants ( 99 % ) . 136 ( 91 % ) intervention patients received one or two visits . 134 admissions occurred in the intervention group compared with 112 in the control group ( rate ratio=1.15 , 95 % confidence interval 0.89 to 1.48 ; P=0.28 , Poisson model ) . 30 intervention patients died compared with 24 controls ( hazard ratio=1.18 , 0.69 to 2.03 ; P=0.54 ) . Although EQ-5D scores favoured the intervention group , Minnesota living with heart failure question naire scores favoured controls ; neither difference was statistically significant . Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure . Given that heart failure accounts for 5 % of hospital admissions , these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits . Trial registration number IS RCT N59427925 PURPOSE The effect of pharmaceutical care services for home care patients with heart failure on death and rehospitalization rates  was studied . METHODS Eligible patients had to be at least 21 years old and included those with a primary or secondary diagnosis of heart failure who were referred to receive skilled nursing services . Patients were then r and omized to receive usual care or pharmaceutical care . Patients assigned to the usual care group received the services typically provided by the visiting nurses association , while patients in the pharmaceutical care group received usual care plus st and ardized services from a clinical pharmacist . Pharmaceutical care services consisted of an initial comprehensive in home medication assessment and two follow-up visits . Throughout the three-week intervention period , the clinical pharmacist accessed and review ed all pertinent physician notes and laboratory test values and interacted with prescribers on behalf of the patients as necessary . RESULTS A total of 154 patients met all criteria and participated in the study . The pharmacist made 79 specific therapy recommendations , 47 ( 60 % ) of which were related directly to drug therapy for heart failure or cardiovascular disease . Overall , 14 therapy recommendations were fully implemented , and 10 heart failure-specific recommendations were fully implemented . Patients for whom the pharmacist had made recommendations that were followed by the prescriber had a reduced rate of the composite primary endpoint , but this difference did not reach statistical significance . CONCLUSION A home-based pharmaceutical care model for recently hospitalized patients with heart failure did not significantly improve the combined rate of death or rehospitalization OBJECTIVES A number of studies have reported that the risk of bleeding associated with warfarin is highest early in the course of therapy . This study examined the effect of a programme focused on the transition of newly anticoagulated patients from hospital to the community . DESIGN Open-label r and omized controlled trial . SETTING Home-based follow-up of patients discharged from acute care hospital in southern Tasmania , Australia . SUBJECTS A total of 128 patients initiated on warfarin in hospital and subsequently discharged to general practitioner ( GP ) care were enrolled in the study . Sixty were r and omized to home monitoring ( HM ) and 68 received usual care ( UC ) . INTERVENTIONS HM patients received a home-visit by the project pharmacist and point-of-care international normalized ratio ( INR ) testing on alternate days on 4 occasions , with the initial visit two days after discharge . The UC group was solely managed by the GP and only received a visit 8 days after discharge to determine anticoagulant control . RESULTS At discharge , 42 % of the HM group and 45 % of the UC group had a therapeutic INR . At day 8 , 67 % of the HM patients had a therapeutic INR , compared with 42 % of UC patients ( P < 0.002 ) . In addition , 26 % of UC patients had a high INR , compared with only 4 % of HM patients . Bleeding events were assessed 3 months after discharge and occurred in 15 % of HM patients , compared with 36 % of the UC group ( P < 0.01 ) . CONCLUSIONS This programme improved the initiation of warfarin therapy and result ed in a significant decrease in haemorrhagic complications in the first 3 months of therapy OBJECTIVE To assess whether home-based medication review by a pharmacist for at-risk older patients in a primary care setting can reduce hospital admissions . DESIGN R and omised controlled trial comparing home-based medication review with st and ard care . SETTING Home-based medication review of 136 patients registered with one general practice . METHOD Study participants were over 80 years of age , living at home , taking four or more medicines , and had at least one additional medicines-related risk factor . The intervention comprised two home visits by a community pharmacist who educated the patient/carer about their medicines , noted any pharmaceutical care issues , assessed need for an adherence aid , and subsequently met with the lead GP to agree on actions . MAIN OUTCOME MEASURE Total non-elective hospital admissions within 6 months . Secondary outcomes included number of deaths , care home admissions and quality of life ( EQ-5d ) . Impact on number of medicines prescribed was also assessed . RESULTS At 6 months , no difference in hospital admissions ( 21 intervention versus 20 control P = 0.80 ) , and no difference in care home admissions or deaths were detected between groups . There was a small ( non-significant ) decrease in quality of life in the intervention group . There was a statistically significant reduction in the mean number of medicines prescribed ( -0.87 items in favour of the intervention group , 95 % confidence interval -1.66 to -0.08 , P = 0.03 ) . CONCLUSIONS No positive impact on clinical outcomes or quality of life was demonstrated , however , this intervention did appear to reduce prescribing . This is in line with other evidence and suggests that this form of intervention may not have a clear health gain , but may lead to modest savings in terms of reduced prescribing . Future research should focus on whether such a prescribing effect would make this type of intervention cost effective Background Elderly polypharmacy patients may be more at risk of not adhering to medication . If so , the underlying reasons may be more readily disclosed during private discussion s with patients . Hence pharmaceutical care discussion s at home might improve treatment adherence . Objective The aim of this study was to investigate the impact of pharmaceutical care on medication adherence , hospitalisation and mortality in elderly patients prescribed polypharmacy . Setting Pharmaceutical care discussed at home . Methods A r and omised controlled trial with two arms ; pharmaceutical care ( n = 315 ) and controls ( n = 315 ) was design ed . It involved patients aged 65 + years living in Aarhus , Denmark who used five drugs or more without assistance .  Pharmacists visited the pharmaceuticalcare patients at home , once only , and followed them during the subsequent year with three telephone calls  . Non-adherence was measured by a pill-count . Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was < 80 % . The impact of pharmaceutical care on non-adherence and hospitalisation was analysed by 2 × 2 tables , and mortality by Cox regression . Main outcome measure Medication adherence , hospitalisation and mortality . Results The final analyses included 517 patients ( median age 74 years ; females 52 % ) . Dropouts were more frequent for the pharmaceutical-care group than for controls . Pharmacists encountered drug-related problems amongst 72 % of pharmaceutical-care patients . Pharmaceutical-care patients ( 11 % ) and control patients ( 10 % ) were similarly nonadherent ( Odds ratio 1.14 ; 95 
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There was no consistent evidence of an effect on quality of life , medication adherence or knowledge .
Conclusion A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates , and limited evidence of effect on quality of life .