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Background:Rates of emergency hospitalisations are increasing in many countries, leading to disruption in thequality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a keypriority. There have been large-scale evidence reviews to address this issue; however, there have been no reviewsof medication therapies, which have the potential to reduce the use of emergency health-care services. The objectivesof this study were to review systematically the evidence to identify medications that affect emergency hospitaladmissions and prioritise therapies for quality measurement and improvement.Methods:This was a systematic review of systematic reviews. Wesearched MEDLINE, PubMed, the Cochrane Database ofSystematic Reviews & Database of Abstracts of Reviews of Effects, Google Scholar and the websites of ten major fundingagencies and health charities, using broad search criteria. We included systematicreviews of randomised controlled trialsthat examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality ofreviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysedeffect estimates and cross-referencedthe evidence with clinical guidelines.Results:We identified 140 systematic reviews, which included1968 unique randomised controlled trials and 925,364patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidencefor 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the UnitedStates, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary arterydisease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department andanticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics)

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Journal article


BMC Medicine

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Project No: 271 PI: Nik Bobrovitz and Kamal Mahtani