Impact of medication reconciliation on health outcomes: An overview of systematic reviews |
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| Institution: | 1. Hospital Medicine, Clinical Informatics, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA;2. Clinical Informatics, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA;1. Division of General Internal Medicine and Primary Care, Hospital Medicine Service, Brigham and Women''s Hospital, 75 Francis Street, Boston, MA 02115, USA;2. Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA;3. Department of Pediatrics and Internal Medicine, Cincinnati Children''s Hospital Medical Center, 3333 Burnet Avenue, Cincinnatti, OH 45229, USA;4. University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA;1. Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy;2. Center for Applied Medical Statistics. University of Gaziantep, Gaziantep, Turkey;3. Center for Health Services and Nursing Research, School of Public Health, University of Leuven, Leuven, Belgium;4. Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy;1. Dialysis Clinic, Inc, Nashville, TN;2. Duke University School of Medicine, Durham, NC;1. Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands;2. Department of Pharmacy, St. Maartenskliniek, Nijmegen, the Netherlands;3. Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands;4. Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands |
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| Abstract: | BackgroundRecent systematic reviews and meta-analyses suggest that medication reconciliation (MR) is effective in decreasing the risk of medication discrepancies. Nevertheless, the association between MR and subsequent improved healthcare outcomes is not well established.ObjectivesThis systematic review of reviews set out to identify published systematic reviews on the impact of MR programs on health outcomes and to describe key components of the intervention, the health outcomes assessed and any associations between MR and health outcomes.MethodsPubMed, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS were searched from inception to May 2019. Systematic reviews of all study designs, populations, intervention providers and settings that measured patient-related outcomes or healthcare utilization were considered. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Two investigators performed study selection, quality assessment and data collection independently.ResultsFive systematic reviews met the inclusion criteria: 2 were rated as low quality and 3 as critically low quality. Reviews included primary studies in different settings (hospitals, the community and residential aged care facilities) that reported the impact of MR on mortality, length of stay, Emergency Department (ED) visits, readmissions, physician visits and healthcare utilization. Only one review reported results on mortality. However, healthcare utilization, which usually included ED visits and readmissions, was communicated in all reviews. Meta-analyses were conducted in all reviews except one. Medication reconciliation was not consistently found to be associated with improvements in health outcomes.ConclusionsFew systematic reviews support the value of MR in achieving good patient-related outcomes and healthcare utilization improvements. The quality of the systematic reviews was low and the primary studies included commonly involved additional activities related to MR. There was no clear evidence in favor of intervention in mortality, length of stay, ED visits, unplanned readmissions, physician visits and healthcare utilization. |
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| Keywords: | Systematic review Medication reconciliation Outcome assessment Evidence-based practice |
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