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Pharmacy-led medication reconciliation programmes at hospital transitions: A systematic review and meta-analysis.
Open accessAbstract
WHAT IS KNOWN AND OBJECTIVE: Medication reconciliation is recognized as an important tool for the prevention of medication discrepancies and subsequent patient harm at care transitions. However, there is inconclusive evidence as to the impact of medication reconciliation at hospital transitions overall, as well as pharmacy-led medication reconciliation services. This review sought to evaluate the impact of pharmacy-led medication reconciliation interventions on medication discrepancies at hospital transitions and to categorize these interventions as single transition interventions or multiple transitions interventions. METHODS: PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO databases, inclusive from inception to December 2014, were searched. Included studies were published studies in English that compared the effectiveness of pharmacy-led medication reconciliation interventions to usual care and that aimed to assess medication discrepancies at hospital transitions. 'Usual care' was defined as any care where targeted medication reconciliation was not undertaken as an intervention, or if an intervention was conducted, it was not provided by a pharmacist/pharmacy technician. RESULTS AND DISCUSSION: Nineteen studies which involved a total of 15 525 adult patients were included. Eleven studies were randomized controlled trials. Overall, pharmacy-led medication reconciliation intervention usually revealed a trend towards reduction in medication discrepancies, compared with usual care. Seventeen studies involving 18 medication reconciliation interventions targeting the various transitions (admission, 9; discharge, 4; and multiple transitions, 5) were included in the meta-analysis. Compared with usual care, single medication reconciliation interventions at transitions in care (either admission or discharge) showed a significant reduction of 66% in patients with medication discrepancies (RR 0·34; 95% CI: 0·23-0·50) in favour of the intervention. There was no difference between groups for interventions targeting multiple transitions (RR 0·88; 95% CI: 0·77-1·02). Subgroup analyses confined to RCTs showed that there were no differences for target of transition (admission vs. discharge), type of intervention (multifaceted intervention vs. medication reconciliation) and setting (single centre vs. multicentre), nor pharmacists vs. pharmacy technicians (non-RCTs only). Importantly, medication discrepancies of higher clinical impact were more easily identified through pharmacy-led interventions than with usual care. WHAT IS NEW AND CONCLUSION: Pharmacy-led medication reconciliation interventions were found to be an effective strategy to reduce medication discrepancies, and had a greater impact when conducted at either admission or discharge but were less effective during multiple transitions in care. Further studies that are designed to assess the impact of the involvement of pharmacy technicians in medication reconciliation are also needed.
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“No differential effect was observed in the a priori sepsis subgroup of 1,689 patients (508).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [508]
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“The trial, which randomized 3,000 participants, demonstrated no difference in mortality in those allocated to an accelerated strategy of RRT compared with those allocated to a “standard” strategy.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [508]
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“Studies of tools employed to promote SDM in patients with other serious illnesses show improved patient knowledge and awareness of treatment options (595).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [595]
Experimental — accuracy not yet measuredIn the citing paper
“Transfer from ICU to general floor and discharge from the hospital are both vulnerable periods for patients, with high frequency of medication errors and information loss [596–602].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [598]
In the citing paper
“Medication reconciliation has been associated with fewer medication errors [598, 612] and may help reduce hospital readmission [613, 614].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [598]
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- Institute for Healthcare Improvement Medication reconciliation review http://www.ihi.org/resources/Pages/Tools/MedicationReconciliationReview.aspx
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BackgroundAccuracy of medication histories collected by pharmacy technicians during hospital admission
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ResultMedication reconciliation as a medication safety initiative in Ethiopia: a study protocol
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Preventing drug-related adverse events following hospital discharge: the role of the pharmacist
Nicholls, J., MacKenzie, C., & Braund, R. (2017) · Integrated Pharmacy Research and Practice · doi:10.2147/iprp.s104639 · Cited by 22
“It aimed to determine the transition points at which pharmacy involvement is of most benefit and found that when MR was completed at admission or discharge it had more impact than conducting repeated MRs during the multiple transitions within care.(12) A study conducted in Spain looked at reconciliation discrepancies…”
InfluentialMedication errors at hospital admission and discharge in Type 1 and 2 diabetes
Breuker, C., Macioce, V., Mura, T., Audurier, Y., Boegner, C., Jalabert, A., Villiet, M., Castet‐Nicolas, A., Avignon, A., & Sultan, A. (2017) · Diabetic Medicine · doi:10.1111/dme.13531 · Cited by 22
Bock, L. D., Tommelein, E., Baekelandt, H., Maes, W., Boussery, K., & Somers, A. (2018) · Pharmacy · doi:10.3390/pharmacy6010021 · Cited by 22
“The results show a positive influence of a pharmacist-led medication reconciliation upon admission, which is in line with many previous studies [7,8,25].”
ResultMarinović, I., Vrca, V. B., Samardžić, I., Marušić, S., Grgurević, I., Papić, I., Grgurević, D., Brkić, M., Jambrek, N., & Mesarić, J. (2021) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.13431 · Cited by 21
Mekonnen, A. B., Redley, B., Crawford, K., Jones, S., de Courten, B. V., & Manias, E. (2022) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2022.2044786 · Cited by 21
“There is mounting evidence showing the positive health impacts of medication reconciliation interventions [41,42].”
BackgroundSelf-citationPharmacist-driven medication recognition/ reconciliation in older medical patients
Chiarelli, M. T., Antoniazzi, S., Cortesi, L., Pasina, L., Novella, A., Venturini, F., Nobili, A., & Mannucci, P. M. (2020) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2020.07.011 · Cited by 20
A narrative review of evidence to guide deprescribing among older adults
Ie, K., Aoshima, S., Yabuki, T., & Albert, S. M. (2021) · Journal of General and Family Medicine · doi:10.1002/jgf2.464 · Cited by 21
Lee, S., Yu, Y. M., Han, E., Park, M. S., Lee, J. H., & Chang, M. J. (2023) · Yonsei Medical Journal · doi:10.3349/ymj.2022.0620 · Cited by 19
“Pharmacyled medication reconciliation interventions have a greater impact when conducted at either admission or discharge.(26) However, studies have found that not only medication discrepancies, but also comprehensive approaches, such as structured medication review and multidisciplinary cooperation, are required to r…”
BackgroundGao, M. C., Martin, P. B., Motal, J., Gingras, L. F., Chai, C., Maikoff, M. E., Sarkisian, A. M., Rosenthal, N., & Eiss, B. M. (2018) · Quality Management in Health Care · doi:10.1097/qmh.0000000000000168 · Cited by 20
Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application
Turner, K. L., Renfro, C. P., Ferreri, S. P., Roberts, K., Pfeiffenberger, T., & Shea, C. M. (2018) · Applied Clinical Informatics · doi:10.1055/s-0038-1651488 · Cited by 18
Pharmacy-supported interventions at transitions of care: an umbrella review
Lipovec, N. Č., Žerovnik, Š., & Kos, M. (2019) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-019-00833-3 · Cited by 19
Villeneuve, Y., Courtemanche, F., Firoozi, F., Gilbert, S., Desbiens, M.-P., Desjardins, A., Dinh, C., LeBlanc, V. C., & Attia, A. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.11.006 · Cited by 19
Kram, B., Schultheis, J. M., Kram, S. J., & Cox, C. E. (2018) · Journal of Pharmacy Practice · doi:10.1177/0897190018761412 · Cited by 19
Mekonnen, A. B., McLachlan, A. J., Brien, J.-A. E., Mekonnen, D., & Abay, Z. (2018) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-018-0722-9 · Cited by 18
Self-citationGuilcher, S. J. T., Fernandes, O. A., Luke, M. J., Wong, G. G., Lui, P., Cameron, K., Pariser, P., Raco, V., Kak, K., Varghese, S., et al. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-4909-0 · Cited by 18
“There is growing interest in actively involving community pharmacists as part of interprofessional teams of healthcare providers that help people navigate transitions between hospital and the community [9, 10].”
BackgroundPartnered pharmacist medication charting and prescribing in Australian hospitals
Tong, E., & Yip, G. S. (2024) · Australian Prescriber · doi:10.18773/austprescr.2024.011 · Cited by 18
A Collaboration Among Primary Care–Based Clinical Pharmacists and Community‐Based Health Coaches
Sorensen, A., Grotts, J. F., Tseng, C., Moreno, G., Maranon, R., Whitmire, N., Viramontes, O., Atkins, S., Sefilyan, E., Simmons, W. J., et al. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16839 · Cited by 19
“Previous care transition programs have incorporated pharmacists, but have generally done so at the time of hospital discharge to perform medication reconciliation.(23) Although beneficial, this approach does not allow the pharmacists to access a patient’s full list of medications or provide information about how a pat…”
BackgroundLindén-Lahti, C., Holmström, A.-R., Pennanen, P., & Airaksinen, M. (2019) · Pharmacy Practice · doi:10.18549/pharmpract.2019.4.1583 · Cited by 17
“14,26,27 In this study some hospitals planned to implement medication reconciliation but ended to implement “only” medication list.”
A Pharmacist-Led Transitional Care Program to Reduce Hospital Readmissions in Older Adults.
Rottman‐Sagebiel, R., Cupples, N., Wang, C. P., Cope, S., Pastewait, S., Braden, H., MacCarthy, D., Martel, A. C., Moris, M., Gonzalez, E.-Y., et al. (2018) · Europe PMC (PubMed Central) · Cited by 17
Pharmacy student involvement in a transition of care program
Hertig, R., Ackerman, R., Zagar, B., & Tart, S. B. (2017) · Currents in Pharmacy Teaching and Learning · doi:10.1016/j.cptl.2017.06.004 · Cited by 16
Corral-Gudino, L., Cengotita-Bengoa, M. B., Sánchez, R. J. J., & Aparicio, J. G. (2017) · Anales del Sistema Sanitario de Navarra · doi:10.23938/assn.0119 · Cited by 15
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Couderc, A., Boisseranc, C., Rey, D., Nouguerède, E., Greillier, L., Barlési, F., Duffaud, F., Deville, L., Honoré, S., Villani, P., et al. (2020) · Clinical Interventions in Aging · doi:10.2147/cia.s262209 · Cited by 16
Ebbens, M. M., Handoko, K. B., Wesselink, E. J., & van den Bemt, P. M. L. A. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.03.022 · Cited by 15
Pharmacists Without Access to the EHR: Practicing with One Hand Tied Behind Our Backs
Craddock, D., & Hall, R. G. (2021) · INNOVATIONS in pharmacy · doi:10.24926/iip.v12i3.4141 · Cited by 15
Roles for Pharmacy Technicians in Medication Reconciliation During Transitions of Care
Fabiili, N. A., & Powers, M. F. (2016) · Journal of Pharmacy Technology · doi:10.1177/8755122516680621 · Cited by 15
The incidence and severity of errors in pharmacist-written discharge medication orders
Onatade, R., Sawieres, S., Veck, A., Smith, L., Gore, S., & Al-Azeib, S. (2017) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-017-0468-9 · Cited by 15
Challenges at Care Transitions: Failure to Follow Medication Changes Made at Hospital Discharge
Weir, D. L., Motulsky, A., Abrahamowicz, M., Lee, T. C., Morgan, S. G., Buckeridge, D. L., & Tamblyn, R. M. (2019) · The American Journal of Medicine · doi:10.1016/j.amjmed.2019.05.003 · Cited by 15
Johnson, K. L., Fuji, K. T., Franco, J. V., Castillo, S., O'Brien, K., & Begley, K. J. (2018) · INNOVATIONS in pharmacy · doi:10.24926/iip.v9i4.1382 · Cited by 16
Koprivnik, S., Pérez, M. S. A., Sandomingo, L. L., Taboada‐López, R. J., & Penín, I. R. (2020) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-020-00968-8 · Cited by 14
Development of a primary care pharmacy outcomes framework: An umbrella literature review
Weir, N., Preston, K., Newham, R., & Bennie, M. (2021) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2021.07.010 · Cited by 15
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Dispensing Process, Medication Reconciliation, Patient Counseling, and Medication Adherence
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Evaluation of a simulation-based hospital pharmacy training package for pharmacy students
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Johnsgård, T., Elenjord, R., Lehnbom, E. C., Risør, T., Zahl-Holmstad, B., Holis, R. V., Ofstad, E. H., & Garcia, B. H. (2023) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2023.2226941 · Cited by 13
“She believes that pharmacists’ in-depth knowledge about medications and their use should be utilized to a greater extent to increase medication safety and prevent MRPs.”
BackgroundInfluentialBaker, M., Bell, C. M., Xiong, W., Etchells, E. E., Rossos, P. G., Shojania, K. G., Lane, K., Tripp, T., Lam, M., Tiwana, K., et al. (2017) · Journal of Hospital Medicine · doi:10.12788/jhm.2857 · Cited by 13
Metadata
- Authors
- Mekonnen, A. B., McLachlan, A. J., & Brien, J.-A. E.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Mekonnen, Alemayehu B.
- Venue
- Journal of Clinical Pharmacy and Therapeutics
- Publisher
- Wiley
- Published
- 2016-02-23
- Volume
- 41
- Issue
- 2
- Pages
- 128-144
- ISSN
- 0269-4727 (ISSN-L)
- OpenAlex
- W2274951248
- Cited by
- 309
- References
- 45
- Citations by year
- 2026: 28 · 2025: 19 · 2024: 26 · 2023: 26 · 2022: 29 · 2021: 40 · 2020: 36 · 2019: 30 · 2018: 43 · 2017: 20 · 2016: 12
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Pharmacy and Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Keywords
- medication reconciliation, hospital transition, medication discrepancies, pharmacist involvement, patient safety, hospitalization, hospital discharge, care transitions, medication errors, pharmacy technicians, multicomponent intervention, usual care
- MeSH terms
- Hospitals, Humans, Patient Admission, Patient Discharge, Patient Transfer, Pharmacists, Pharmacy Service, Hospital, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Medication Reconciliation
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