Table 1 Study characteristics

 Basger et al. [31]

216 elderly patients admitted to a small private hospital, taking ≥5 medicines, Australia

Medication counselling, Medicines reconciliation, Medication review to detect drug related problems, Self-management discussions, Information transfer

 Bolas et al. [27]

162 patients admitted for unplanned causes to the medical admissions unit, taking ≥3 long term medicines, Northern Ireland

Preparation of full medication history, Medicines reconciliation, Patient education and discharge counselling, Pharmaceutical discharge letter, Personalised medicines record sheet, Medicines helpline

 Graabaek et al. [34]

400 patients, admitted to the medical acute unit, Denmark

Structured medication review, Medicines reconciliation, Recommendations for change reported to clinician, Medication report created to aid clinician preparing discharge, Patient counselling

 Hockly et al. [33]

33 patients, taking ≥4 medicines, UK

Information transfer

 Lalonde et al. [29]

83 patients, being discharged with ≥2 medicines changes, Canada

Medication Discharge Plan created and given to patient at discharge, Transfer of information to Primary Care Provider and Community Pharmacist by fax

 Legrain et al. [30]

665 patients, admitted to the acute geriatric unit with stays longer than 5 days, France

Comprehensive chronic medication review, Medicines reconciliation, Patient education and self-management discussion, Transition of care communication with outpatient healthcare professionals

 Scullin et al. [28]

762 elderly patients, admitted to medical wards, taking ≥4 long term medicines OR one high risk medicines OR previous admission within last 6 months OR given an IV antibiotic on day one of admission, Northern Ireland

Medicines reconciliation, Medication review, Counselling, Medicines record sheet, Information transfer

 Tamblyn et al. [35]

4656 patients, discharged from internal medicine, cardiac or thoracic surgery units, Canada

Electronic medicines reconciliation, Information transfer

 Tong et al. [32]

832 patients, admitted to general medical unit at an adult major referral hospital, Australia

Personalised medication management plan

 Buurman et al. [48]

674 elderly patients, admitted to the internal medicine ward, Netherlands

Medicines reconciliation, Discussion with Primary Care Provider and additional support enabled, Home visit for patient education

 Casas et al. [43]

155 patients with COPD and minimum admission length of 48 h in two tertiary hospitals, Belgium and Spain

Educational programme (2 h) on self-management, Information transfer, Post-discharge telephone calls, Web-based call centre

 Chan et al. [46]

699 patients, admitted to internal medicines, family medicines, cardiology or neurology wards at a general safety net hospital and trauma centre, USA

Patient education, Self-management coaching, Medicines reconciliation, Written medicines information, Post-discharge telephone calls, Medicines helpline

 Coleman et al. [49]

750 elderly patients, with a long-term condition, with admission to large hospital/ service delivery system, USA

Personalised patient-held record, Home visit for education, Self-management coaching, Medicines reconciliation, Post-discharge telephone calls

 Gillespie et al. [44]

400 elderly patients (> 80 years) admitted to two internal medicines wards at a University Hospital, Sweden

Medicines reconciliation, Medication review, Patient education, Information transfer, Post-discharge telephone call

 Huang and Liang [42]

126 elderly patients, admitted to large medical hospital with hip fracture due to falling, Taiwan

Individualised discharge plan, Information brochure, Patient education, Home visit, Post-discharge telephone calls, Medicines helpline, Collaboration with Primary Care Provider

 Koehler et al. [45]

41 elderly patients, taking ≥5 long term medicines and with ≥3 chronic conditions, admitted to a University Hospital, USA

Pharmacist-led medicines reconciliation, Medication review, Patient education including self-management, Post-discharge telephone call, Personal health record, Information transfer

 Lee et al. [47]

840 patients, admitted to medical ward of tertiary hospital and at high risk of readmission, Singapore

Patient education, Medicines reconciliation, Medication review, Discharge information, Post-discharge telephone calls, Home visit

 Ravn-Nielsen et al. [50]

974 patients, taking ≥5 medicines, admitted to the acute admission wards, Denmark

Structured medication review, Information transfer, Medicines reconciliation,

30-min motivational interview with patient at discharge for education and self-management, Post-discharge telephone calls

 Ahmad et al. [37]

340 elderly patients, taking ≥5 long term medicines, discharged from general or academic hospitals, Netherlands

Medication review, Medication counselling using cognitive behaviour techniques, Home visit, Medicines reconciliation, Collaboration with Primary Care Provider, Removal of redundant medications from home

 Char et al. [40]

200 patients, taking ≥5 long term medicines, attending first outpatient clinic appointment following recent stay in hospital, Singapore

Medicines reconciliation, Collaboration with Primary Care Provider, Best possible medication history created for patient

 Gurwitz et al. [38]

3661 elderly patients, discharged from hospital for any admission, USA

Information transfer, System prompt to schedule an appointment within one week

 Haag et al. [39]

25 elderly patients, discharged from tertiary care academic medical centre for any type of admission, USA

Post-discharge telephone call, Medication review, Medicines reconciliation, Information transfer

 Holland et al. [36]

872 elderly patients, from 10 hospitals following an emergency admission and taking ≥2 medicines, UK

Home visit, Medication review, Patient education, Collaboration with primary care provider, Removal of redundant medications from home

 Tuttle et al. [41]

159 patients, discharged from large tertiary-referral hospital following acute illness and detection of chronic kidney disease stage 3–5, USA

Home visit, Medicines reconciliation, Medication review, Patient education and self-management strategies, Information transfer