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Systematic review

Overview of reviews on effect of medical reconciliation

  • Year: 2015
  • Authors Holte HH, Hafstad E, Vist GE.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-948-9

In this overview of reviews, we have searched for systematic reviews of effect of medication reconciliation.



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Key message

Many patients suffer from multiple diseases and have to use several medications simultaneously. Errors in medication leads to unintended harm to patients every year. One patient safety intervention is medication reconciliation. This is a process where a health care worker in collaboration with the patient ensures that the information regarding current medications are correct.

In this overview of reviews, we have searched for systematic reviews of effect of medication reconciliation. We included nine systematics reviews. The reviews conclude that:

  • medication reconciliation probably reduces the number of medication discrepancies.
  • review authors point out that there are methodological issues in the primary studies.

There is a need for a high quality systematic review on the effect of medication reconciliation.

Summary

Background

Many patients suffer from multiple diseases and have to use several medications simultaneously. Errors in medication leads to unintended harm to patients every year. One patient safety intervention is medication reconciliation. This is a process where a health care worker in collaboration with the patient ensures that the information regarding current medications are correct.

The Norwegian Knowledge Centre for the Health Services was commissioned by the Western Norway Regional Health Authority to update the documentation for the target areas and specified interventions referred to by the Norwegian Patient Safety Programme. In this overview of reviews, we have searched for systematic reviews published in 2010 or later for the target area “Medication reconciliation”.

Method

We searched for systematic reviews published in 2010 or later about medication reconciliation. By not limiting the search to specific questions of medication reconciliation, we wanted to identify as many systematic reviews on this topic as possible. We searched for reviews in October 2014 in the following databases:

  • Cochrane Database of Systematic Reviews.
  • Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
  • Ovid Embase
  • Cochrane and CRD: Database of Abstracts of Reviews of Effects (DARE)
  • Cochrane and CRD: Health Technology Assessment Database (HTA)
  • CINAHL
  • Web of Science
  • The Knowledge Centre

We used the following inclusion criteria:

Population:       Patients in hospitals or at the family physician

Intervention:    Medication reconciliation

Comparison:    Any other intervention or no intervention

Outcomes:        Health related outcomes, e.g. readmissions, adverse events, unwanted events, but also outcomes related to the process of performing medication reconciliation, e.g. percentage performing medication reconciliation

Languages:      All

Study designs: Systematic review of high quality evaluated by the checklist in the Knowledge Centre Handbook.

Two authors independently read titles and abstracts from the literature search. For abstracts considered potentially relevant, the publication was read in full text, and evaluated according to the inclusion criteria. Independently, we performed an assessment of the methodological quality according to the checklist in the Handbook of the Knowledge Centre.

Results

We did not identify any systematic review of high quality about medication reconciliation published in 2010 or later. Thus, we included the nine reviews of moderate methodological quality. The nine reviews included 26 relevant primary studies, nine of them were published in 2010 or later. The number of relevant studies included in the reviews varied from two to thirteen.

Seven of the eight systematic reviews concluded that medical reconciliation probably reduces the number of medication discrepancies, but that there is too little information to conclude regarding clinical outcomes. Many of the studies included in the reviews have not had clinically important events as outcomes. Most review authors point out that there are methodological challenges with the primary studies. All review authors pointed out problems with heterogeneity in the research.

There were several reasons for downgrading the quality of the reviews. Some reviews had not evaluated the quality of the included studies, and some had included studies with study designs that cannot measure effect. Each of these factors indepen­dently reduce our confidence in the results.

There is a need for high quality reviews about the effect of medication reconciliation.

Discussion

The strength of our systematic review is that the literature has been assessed in a systematic and explicit way. However, there is always a possibility that we may have missed one.

Clinical consequences from mistakes made in medication reconciliation seems to be a relatively rare occurrence. That is a challenge with respect to the study size necessary for evaluating the effect of rare events. Another challenge is the relation between medication reconciliation and medication review. Some studies have not handled these two processes separately. In these cases, it is not possible to conclude if it is the one, or the other, or the combination that has had an effect.

Most studies included in the identified reviews addressed one of two topics: use of electronic devices to prepare a list of the medication currently used by the patient, and support by a pharmacist to perform the medication reconciliation. The setting is probably very important for how the medical reconciliation is performed. Finding research relevant for Norwegian hospitals may therefore be a challenge.

Conclusion

We identified no systematic review of high quality on medication reconciliation published in 2010 or later.

We included nine systematic reviews of moderate quality. Seven of the reviews concluded that medication reconciliation probably reduces the number of medication discrepancies, but that the impact on clinical outcomes is unclear.