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Meta-Analysis
. 2018 Mar 28;13(3):e0193510.
doi: 10.1371/journal.pone.0193510. eCollection 2018.

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials

Ejaz Cheema  1   2 , Farah Kais Alhomoud  3 , Amnah Shams Al-Deen Kinsara  1 , Jomanah Alsiddik  1 , Marwah Hassan Barnawi  1 , Morooj Abdullah Al-Muwallad  1 , Shatha Abdulbaset Abed  1 , Mahmoud E Elrggal  1 , Mahmoud M A Mohamed  1
Affiliations
Meta-Analysis

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials

Ejaz Cheema et al. PLoS One. .

Abstract

Background: Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events.

Objective: To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only.

Methods: Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model.

Results: From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable.

Conclusion: Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Prisma flow diagram representing the selection process of articles included in the review.
Fig 2
Fig 2
(a) Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. 2 (b) Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Fig 3
Fig 3
Forest plot comparisons of experimental (intervention) vs. control groups in four studies for medication discrepancy (A) three studies for potential ADEs (B) three studies for preventable ADEs (C) and four studies for healthcare utilization post-hospital discharge (D). Pharmacists-led interventions included medicine reconciliation and tailored patient counselling post hospital discharge. Farley [27] and Farris [28] used two tiers of pharmacist interventions: enhanced and minimal.
See this image and copyright information in PMC

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