Patrick Redmond|Tamasine Grimes|Ronan McDonnell|Fiona Boland|Carmel M. Hughes|Tom Fahey
Impact of medication reconciliation for improving transitions of care
Royal College of Surgeons in Ireland|University of Cambridge|Trinity College Dublin|Royal College of Surgeons in Ireland|Royal College of Surgeons in Ireland|Queen's University Belfast|Royal College of Surgeons in Ireland
transitional care provides continuity care patients move different stages settings care medication discrepancies arising care transitions reported prevalent linked adverse drug events ades eg rehospitalisationmedication reconciliation process prevent medication errors transitions reconciliation involves building complete list persons medications checking accuracy reconciling documenting changes despite reconciliation recognised key aspect patient safety remains lack consensus evidence effective methods implementing reconciliation calls made strengthen evidence base prior widespread adoptionto assess effect medication reconciliation medication discrepancies patientrelated outcomes healthcare utilisation people receiving intervention care transitions compared people receiving medication reconciliationwe searched central medline embase seven databases two trials registers 18 january 2018 together reference checking citation searching grey literature searches contact study authors identify additional studieswe included randomised trials eligible studies described interventions fulfilling institute healthcare improvement definition medication reconciliation aimed patients experiencing transition care compared standard care institution included studies report medication discrepancies outcometwo review authors independently screened titles abstracts assessed studies eligibility assessed risk bias extracted data studyspecific estimates pooled using randomeffects model yield summary estimates effect 95 confidence intervals ci used grade approach assess overall certainty evidence pooled outcomewe identified 25 randomised trials involving 6995 participants studies conducted hospital immediately related settings eight countries twentythree studies provider orientated pharmacist mediated two structural electronic reconciliation tool medical record changes pooled result 20 studies comparing medication reconciliation interventions standard care participants least one medication discrepancy showed risk ratio rr 053 95 ci 042 067 4629 participants certainty evidence outcome low therefore effect medication reconciliation reduce discrepancies uncertain similarly reconciliations effect number reported discrepancies per participant also uncertain mean difference md 118 95 ci 258 023 4 studies 1963 participants well effect number medication discrepancies per participant medication rr 013 95 ci 001 129 2 studies 3595 participants certainty evidence outcomes lowreconciliation may also little effect preventable adverse drug events pades due low certainty available evidence rr 037 95 ci 009 157 3 studies 1253 participants uncertainty effect ade rr 109 95 ci 091 130 4 studies 1363 participants lowcertainty evidence evidence effect interventions healthcare utilisation conflicting probably made little difference unplanned rehospitalisation reported alone rr 072 95 ci 044 118 5 studies 1206 participants moderatecertainty evidence uncertain effect composite measure hospital utilisation emergency department rehospitalisation rr 078 95 ci 050 122 4 studies 597 participants lowcertainty evidencethe impact medication reconciliation interventions particular pharmacistmediated interventions medication discrepancies uncertain due certainty evidence low also certainty effect interventions secondary clinical outcomes ades pades healthcare utilisation