Interventions for improving medication reconciliation across transitions of care - a systematic review

The problem

Errors in prescribing and administration of medication are frequent, costly and harmful. More than 40% of errors take place as a result of inadequate reconciliation of medications at care transitions . Despite reconciliation being recognised as a key aspect of patient safety there remains a lack of consensus and evidence regarding the most effective methods of implementing reconciliation and calls have been made to strengthen the evidence base prior to widespread adoption.The approach :We conducted a systematic review to assess the effect of medication reconciliation on medication discrepancies, patient-related outcomes and healthcare utilisation in patients experiencing a care transition. We included randomised controlled trials that reported our primary outcome of medication discrepancies . There was no restriction on age, gender, ethnicity, location or patient population. Studies were eligible for inclusion, irrespective of language, publication date or status. The protocol was registered and the review conducted under the guidance of the Effective Practice and Organisation of Care (EPOC) Cochrane review group. The search strategy, in line with Cochrane Handbook guidance, included primary study databases, reference searching, grey literature, trial registries, conference proceedings, expert contacts and hand searching.Findings : Twenty one studies were included, involving 6391 patients (USA=7, Australia=5, Canada=3, France=1, Colombia=1, Netherlands=1, Egypt=1, Singapore=1, Northern Ireland=1). All studies focused on adults only, with 6 involving patients 50 years or older. Most studies focused on specific patient types (Heart disease=2, chronic disease=2, surgical patients=4, “high risk” for readmission=1, general medical patients=3, oncology=1), whilst the remainder made no distinction regarding patients/settings. Fourteen studies involved hospital inpatients, 3 surgical pre-admission clinics, 2 in primary care and one each in long term care and an outpatient department. Nine studies targeted patients being discharged, 4 studies targeted both admission and discharge. The pharmacist was the most commonly involved healthcare professional, centrally involved in 16 of the studies’ interventions whether in acquiring medication histories, coordinating transitions or taking on a new role of prescribing medication. Only one study investigated an ICT intervention.Consequences : This is the first systematic review of medication reconciliation registered as a Cochrane title. Data extraction, risk of bias and meta-analysis are still underway. This review differs from previously published reviews in the area in that it focuses on the primary outcome of medication discrepancy and is rigorous in its study design eligibility, being limited to RCTs only. This confirms pharmacist mediated interventions as being the most well studied, with evidence for paediatric populations and ICT interventions lacking. The findings of this review will be important to those involved in prescribing and medication safety, policy makers and workforce decision planners.

Credits

• Patrick Redmond, School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
• Tamasine Grimes, School of Pharmacy, Queen's University Belfast, Belfast, UK
• Ronan McDonnell, School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
• Fiona Boland, School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
• Carmel Hughes
• Tom Fahey, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland