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


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Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, and Health Technology Assessments; and unpublished material.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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    • "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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    • "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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