SCP: Medication Reconciliation Summary of evidence for effectiveness


The effect of hospital-based Medication Reconciliation on medication errors and (potential) adverse drug events has been investigated in many studies and summarized in systematic reviews (Mueller et al 2012, Kwan et al 2013). Both reviews come to the conclusion that Medication Reconciliation is a potentially promising intervention.

The systematic review by Mueller et al 2012 included 26 controlled studies and reasoned that Medication Reconciliation consistently reduced medication discrepancies, potential adverse drug events (i.e., clinically significant discrepancies) and adverse drug events. The impact on post discharge health care utilization (i.e., readmissions) was inconsistently shown. Key aspects of a successful intervention included pharmacy staff involvement and focusing on a high risk patient population. The study quality was judged to be poor in fifteen of the 26 studies (Mueller et al 2012).

The systematic review by Kwan et al 2013 included eighteen studies evaluating 20 interventions. Inclusion criteria were more restrictive than in the previously described review; only studies evaluating clinically significant unintended discrepancies or emergency department visits and readmission within 30 days of discharge were considered. The authors come to the conclusion that hospital-based Medication Reconciliation at care transitions frequently identifies unintended discrepancies; however few of these discrepancies seem to have a clinical significance. Furthermore, Medication Reconciliation alone probably does not reduce postdischarge hospital utilization within 30 days but may do so when bundled with other interventions that improve discharge coordination1. Like the previously described review, this review also found that pharmacists play a major role in successful interventions; however, contrary to the other review, focusing on high risk patients did not seem to consistently improve the effect of Medication Reconciliation (Kwan et al 2013).

A systematic review on the effectiveness of Medication Reconciliation in the primary care setting concluded that there is no high quality evidence on this subject and that further research is needed. Four studies were included in this review, of which two studies were conducted in ambulatory care and two studies in the posthospital discharge setting (Bayoumi et al 2009).

The authors note that the benefits of resolving unintended discrepancies may not become apparent for months after discharge, and suggest that future research should examine the effect of Medication Reconciliation on postdischarge hospital utilization at time points extending past the traditional 30-day mark.