Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge

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.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…It is anticipated from our identified rate of error/harm that the cost of "no action taken" is high in terms of a patient's subsequent use of the healthcare services post-hospital discharge. A number of reviews have been published that evaluated interventions (including medication reconciliation, community pharmacy involvement and electronic communication interventions) to reduce MEs and ADEs post-discharge [140][141][142][143][144][145][146]. However, none have reported consistent reductions in these outcomes.…”

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis

“…7,11,[57][58][59][60] Rodrigues et al 7 examined the effect of pharmacy-supported transitions of care interventions and Community pharmacists and transitions: A systematic review found a 32% reduction in 30-day readmissions (odds ratio 0.68; 95% CI 0.61-0.75), 7 and Mekonnen et al 58 examined the impact of medication reconciliation programs at transitions of care and found a 19% reduction in readmissions (RR, 0.81; 95% CI 0.70-0.95) 58 ; however, neither study was focused on community pharmacy. McNab et al 60 examined community pharmacist involvement on medication reconciliation, but not exclusively, and found a 9% reduction in readmissions (RR, 0.91; 95% CI 0.66-1.25). 60 Nazar et al 11 used similar inclusion criteria to our study and included 14 studies.…”

“…McNab et al 60 examined community pharmacist involvement on medication reconciliation, but not exclusively, and found a 9% reduction in readmissions (RR, 0.91; 95% CI 0.66-1.25). 60 Nazar et al 11 used similar inclusion criteria to our study and included 14 studies. They identified heterogeneity in the outcomes measured and descriptively summarized the interventions and outcomes.…”

Medicines‐related harm in the elderly post‐hospital discharge

“…Pharmacists' completion of medicines reconciliation in the community post-discharge has been proven to help identify and resolve medication discrepancies. 48 Closer monitoring of high-risk patients on high-risk medications requires proactive management in primary care. This can be done by ensuring there is a system in place at GP surgeries to flag up discharges that require a quicker follow-up or discharges that are higher risk, so any gaps in communication can be addressed.…”