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

McNab, D., Bowie, P., Ross, A. , MacWalter, G., Ryan, M. and Morrison, J. (2018) A systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge. BMJ Quality and Safety, 27(4), pp. 308-320. (doi: 10.1136/bmjqs-2017-007087) (PMID:29248878) (PMCID:PMC5867444)

Abstract

BACKGROUND Pharmacists’ 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. DESIGN Systematic literature review and meta-analysis of extracted data. METHODS Medline, CINHAL, EMBASE, AMED, ERIC, SCOPUS, NHS evidence and the Cochrane databases were searched using a combination of Medical Subject Heading (MeSH) 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 CASP. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively. RESULTS Fourteen studies were included comprising five RCTs, 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. CONCLUSIONS Pharmacists 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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ryan, Professor Martin and Morrison, Professor Jill and Bowie, Dr Paul and McNab, Duncan and Ross, Dr Alastair
• Authors: McNab, D., Bowie, P., Ross, A., MacWalter, G., Ryan, M., and Morrison, J.
• Subjects: R Medicine > R Medicine (General); R Medicine > RS Pharmacy and materia medica
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: BMJ Quality and Safety
• Publisher: BMJ Publishing Group
• ISSN: 2044-5415
• ISSN (Online): 2044-5423
• Published Online: 16 December 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in BMJ Quality and Safety 27(4):308-320
• Publisher Policy: Reproduced under a Creative Commons License