Interventions to Improve Medication Reconciliation in Primary Care

Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
Annals of Pharmacotherapy (Impact Factor: 2.06). 10/2009; 43(10):1667-75. DOI: 10.1345/aph.1M059
Source: PubMed

ABSTRACT To systematically review all primary care intervention studies designed to implement medication reconciliation for effects on medication discrepancies, clinical outcomes, and patient knowledge of their medications.
We searched MEDLINE (1988-March 2008); Healthstar (1966-March 2008); CINAHL (1982-March 2008); EMBASE (1980-March 2008); Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, and Health Technology Assessments; and unpublished material. No language restrictions were applied. Search terms included medication reconciliation, medication errors, prescribing error, medication systems, adverse drug events, drug utilization review, medication list, medication record, and medications management.
Randomized controlled trials or before-and-after studies that examined the effect of various interventions on medication discrepancies either in ambulatory settings or at hospital discharge among community-dwelling adults were included. Two reviewers independently assessed studies to determine inclusion. Level of agreement between the reviewers was good, with unweighted Cohen's kappa of 0.71. Two of 3 independent reviewers abstracted data and evaluated validity from included studies. Disagreements between reviewers were resolved by consensus.
Four trials met the inclusion criteria. Two before-and-after studies (n = 275) in ambulatory care examining systematic medication reconciliation at each visit produced conflicting results. One study showed a reduction in the proportion of medication discrepancies from 88.5% to 49.1% (OR 0.13; 95% CI 0.07 to 0.21); the other showed no benefit. One randomized controlled trial and one before-and-after study (n = 202) evaluated pharmacist medication review at hospital discharge. Neither showed a benefit. Heterogeneity precluded pooling of studies. All included studies had significant design flaws.
There is no good quality evidence demonstrating the effectiveness of medication reconciliation in the primary care setting. Further research is needed.

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Available from: Michelle Howard, Jul 18, 2014
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    • "The majority of the studies (51, 65%) focussed on interventions to improve adherence either in any disease area (20; 39%) or for specific conditions (31; 69%). Interventions were mostly educational (35; 69%) such as leaflets or brochures,76 behavioural or counselling (24; 47%) such as group psychotherapy, cognitive behavioural therapy72 or family counselling therapy77 or involving adherence aids (19; 37%) such as unit-of-use packaging,33 reminders such as telephone reminders68 or dose simplifications.29 One review evaluated the effectiveness of incentives of the form of money, goods (such as bus tokens or food) or vouchers redeemable for goods to improve adherence to medications for tuberculosis, substance abuse, human immunodeficiency virus, hepatitis C, schizophrenia and stroke prevention.43 "
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    ABSTRACT: Background: This review scopes the evidence on the effectiveness and cost-effectiveness of interventions to improve suboptimal use of medicines in order to determine the evidence gaps and help inform research priorities. Sources of data: Systematic searches of the National Health Service (NHS) Economic Evaluation Database, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. Areas of agreement: The majority of the studies evaluated interventions to improve adherence, inappropriate prescribing and prescribing errors. Areas of controversy: Interventions tend to be specific to a particular stage of the pathway and/or to a particular disease and have mostly been evaluated for their effect on intermediate or process outcomes. Growing points: Medicines optimization offers an opportunity to improve health outcomes and efficiency of healthcare. Areas timely for developing research: The available evidence is insufficient to assess the effectiveness and cost-effectiveness of interventions to address suboptimal medicine use in the UK NHS. Decision modelling, evidence synthesis and elicitation have the potential to address the evidence gaps and help prioritize research.
    British Medical Bulletin 09/2014; 111(1):45-61. DOI:10.1093/bmb/ldu021 · 3.66 Impact Factor
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    • "A 2009 meta-analysis of studies conducted in primary care demonstrated a lack of quality information on the impact of medication reconciliation.11 The studies included in the meta-analysis provided conflicting evidence on the potential for medication reconciliation in ambulatory care to demonstrate a reduction in the rate of discrepancies and the proportion of charts with a discrepancy present. "
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    ABSTRACT: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR). Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence. There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans. While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.
    03/2014; 12(1):360. DOI:10.4321/S1886-36552014000100004
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    • "In the ambulatory setting, there is little direct evidence to support any one method of medication review as superior to another.123 Even so, a method that has been advocated for is the “brown bag” review. "
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    ABSTRACT: The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
    Clinical Interventions in Aging 06/2013; 8:749-763. DOI:10.2147/CIA.S37738 · 2.08 Impact Factor
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