Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
Open Access
- 16 December 2017
- journal article
- review article
- Published by BMJ in BMJ Quality & Safety
- Vol. 27 (4), 308-320
- https://doi.org/10.1136/bmjqs-2017-007087
Abstract
BackgroundPharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.MethodsThis is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.ResultsFourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre–post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.ConclusionsPharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.Keywords
This publication has 34 references indexed in Scilit:
- Pharmacist directed home medication reviews in patients with chronic heart failure: A randomised clinical trialInternational Journal of Cardiology, 2012
- Effect of a Pharmacist Intervention on Clinically Important Medication Errors After Hospital DischargeAnnals of Internal Medicine, 2012
- Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health careAmerican Journal of Health-System Pharmacy, 2009
- Medication reconciliation for reducing drug-discrepancy adverse eventsThe American Journal of Geriatric Pharmacotherapy, 2006
- Effect of a nurse team coordinator on outcomes for hospitalized medicine patientsAmerican Journal Of Medicine, 2005
- Does home based medication review keep older people out of hospital? The HOMER randomised controlled trialBMJ, 2005
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trialAge and Ageing, 2001
- Reducing Adverse Prescribing Discrepancies Following Hospital DischargeInternational Journal of Pharmacy Practice, 1998