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

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 literatu...

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Autores principales: McNab, Duncan, Bowie, Paul, Ross, Alastair, MacWalter, Gordon, Ryan, Martin, Morrison, Jill
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867444/
https://www.ncbi.nlm.nih.gov/pubmed/29248878
http://dx.doi.org/10.1136/bmjqs-2017-007087
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author McNab, Duncan
Bowie, Paul
Ross, Alastair
MacWalter, Gordon
Ryan, Martin
Morrison, Jill
author_facet McNab, Duncan
Bowie, Paul
Ross, Alastair
MacWalter, Gordon
Ryan, Martin
Morrison, Jill
author_sort McNab, Duncan
collection PubMed
description 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. METHODS: This 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. RESULTS: Fourteen 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. 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.
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spelling pubmed-58674442018-03-27 Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge McNab, Duncan Bowie, Paul Ross, Alastair MacWalter, Gordon Ryan, Martin Morrison, Jill BMJ Qual Saf Systematic Review 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. METHODS: This 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. RESULTS: Fourteen 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. 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. BMJ Publishing Group 2018-04 2017-12-16 /pmc/articles/PMC5867444/ /pubmed/29248878 http://dx.doi.org/10.1136/bmjqs-2017-007087 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Systematic Review
McNab, Duncan
Bowie, Paul
Ross, Alastair
MacWalter, Gordon
Ryan, Martin
Morrison, Jill
Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title_full Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title_fullStr Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title_full_unstemmed Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title_short Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
title_sort systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867444/
https://www.ncbi.nlm.nih.gov/pubmed/29248878
http://dx.doi.org/10.1136/bmjqs-2017-007087
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