Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis

Abstract

ObjectivesPharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients’ clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions.DesignSystematic review and meta-analysis.MethodsWe searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity.Results17 studies involving 21 342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results.ConclusionPharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.

An admission medication reconciliation programme carried out by pharmacists: impact on surgeons' prescriptions

“…Once the patients were selected based on the criteria described above, the best possible medication history (BMH)10 was obtained using all the digital sources available, including the home medication form. If any discrepancies were found between the sources, the pharmacist called the patient for clarification (figure 1, step II).…”

Evidence-Based Pharmacy Practice?

“…In 2 recent metaanalyses, pharmacist-led medication reconciliation programs were shown to reduce medication discrepancies, but with variable to no benefits in terms of clinically significant discrepancies. 7,8 Furthermore, these studies showed no effect on more concrete outcomes, such as mortality, readmission rates, and harm from medications (or from omission of medications). In fact, the intervention arm of many of the randomized controlled trials in the 2016 meta-analyses 7,8 included a "bundle" of pharmacist functions, only one of which was medication reconciliation.…”

“…7,8 Furthermore, these studies showed no effect on more concrete outcomes, such as mortality, readmission rates, and harm from medications (or from omission of medications). In fact, the intervention arm of many of the randomized controlled trials in the 2016 meta-analyses 7,8 included a "bundle" of pharmacist functions, only one of which was medication reconciliation. For example, in the often-quoted study by Gillespie and others, 9 the intervention included medication counselling, medication review during the inpatient admission, and postdischarge follow-up by telephone.…”

Une pratique de la pharmacie fondée sur des données probantes?

“…Cependant, les données appuyant un bilan comparatif des médicaments exhaustif, une tâche à laquelle bon nombre de pharmaciens, de techniciens, de praticiens d'autres disciplines en santé et d'administrateurs ont consacré d'innombrables heures, ne font pas le poids face aux ressources qu'on investit dans le processus. Dans deux méta-analyses récentes, on a remarqué que les programmes de bilan comparatif des médicaments dirigés par des pharmaciens réduisaient les divergences relatives aux médicaments, mais pour ce qui est des divergences cliniquement significatives, les avantages étaient variables ou inexistants 7,8 . De plus, ces études ne montrent aucun effet sur des résultats plus concrets, comme les taux de mortalité, les taux de réadmission et les préjudices provoqués par les médicaments (ou par l'omission d'un traitement médica-menteux).…”

“…De plus, ces études ne montrent aucun effet sur des résultats plus concrets, comme les taux de mortalité, les taux de réadmission et les préjudices provoqués par les médicaments (ou par l'omission d'un traitement médica-menteux). En fait, pour bon nombre d'essais comparatifs à répartition aléatoire dans les méta-analyses de 2016 7,8 , le groupe expérimental incluait un « ensemble » de fonctions du pharmacien, dont le bilan comparatif des médicaments. Par exemple, dans l'étude souvent citée de Gillespie et collab.…”