Hassan Rao, MD

Clinical question: Does pharmacist-led medication reconciliation in the community after hospital discharge reduce health care utilization, readmission rates, ED visits, primary care visits, or primary care workload?

Background: Accurate medication reconciliation is essential to ensure safe transitions of care after hospital discharge. Studies have shown that harm from prescribed or omitted medications is higher after discharge and pharmacist-led medication reconciliation on discharge has been shown to improve clinical outcomes. The effect of medication reconciliation after discharge performed by primary care and community-based pharmacist is unclear.

Study design: A meta-analysis.

Setting: This meta-analysis included five randomized, controlled trials, six cohort studies, two pre- and postintervention studies performed in the United Kingdom and United States as well as one quality improvement project performed in Canada.

Synopsis: The studies included demonstrated that community-based pharmacists were more effective at identifying and resolving discrepancies, compared with usual care, but the clinical relevance was unclear. There was no evidence that this reduced readmission rates. Because of the the heterogeneity of the settings, methods, and data reporting in the included trials, no firm conclusion could be drawn regarding the impact on either ED visits and primary care burden, and no consistent evidence of benefit was found. The benefit in clinical outcomes seen in prior studies may be related to other interventions, including patient education, medication review, and improved communication with primary care physicians. This study aimed to specifically isolate the impact of postdischarge, pharmacist-led medication reconciliation, and further research is still needed to understand the clinical relevance of medication discrepancies and which pharmacist-led interventions are most important.

Bottom line: Community-based pharmacists can identify and resolve discrepancies while performing medication reconciliation after hospital discharge, but there is no conclusive benefit in clinical outcomes, such as readmission rates, health care utilization, and primary care visits.

Citation: McNab D et al. Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge. BMJ Qual Saf. 2017 Dec 16. pii: bmjqs-2017-007087. doi: 10.1136/bmjqs-2017-007087.

Dr. Rao is a hospitalist at Denver Health Medical Center and an assistant professor of medicine at the University of Colorado at Denver, Aurora.

Clinical question: Does pharmacist-led medication reconciliation in the community after hospital discharge reduce health care utilization, readmission rates, ED visits, primary care visits, or primary care workload?

Background: Accurate medication reconciliation is essential to ensure safe transitions of care after hospital discharge. Studies have shown that harm from prescribed or omitted medications is higher after discharge and pharmacist-led medication reconciliation on discharge has been shown to improve clinical outcomes. The effect of medication reconciliation after discharge performed by primary care and community-based pharmacist is unclear.

Study design: A meta-analysis.

Setting: This meta-analysis included five randomized, controlled trials, six cohort studies, two pre- and postintervention studies performed in the United Kingdom and United States as well as one quality improvement project performed in Canada.

Synopsis: The studies included demonstrated that community-based pharmacists were more effective at identifying and resolving discrepancies, compared with usual care, but the clinical relevance was unclear. There was no evidence that this reduced readmission rates. Because of the the heterogeneity of the settings, methods, and data reporting in the included trials, no firm conclusion could be drawn regarding the impact on either ED visits and primary care burden, and no consistent evidence of benefit was found. The benefit in clinical outcomes seen in prior studies may be related to other interventions, including patient education, medication review, and improved communication with primary care physicians. This study aimed to specifically isolate the impact of postdischarge, pharmacist-led medication reconciliation, and further research is still needed to understand the clinical relevance of medication discrepancies and which pharmacist-led interventions are most important.

Bottom line: Community-based pharmacists can identify and resolve discrepancies while performing medication reconciliation after hospital discharge, but there is no conclusive benefit in clinical outcomes, such as readmission rates, health care utilization, and primary care visits.

Citation: McNab D et al. Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge. BMJ Qual Saf. 2017 Dec 16. pii: bmjqs-2017-007087. doi: 10.1136/bmjqs-2017-007087.

Dr. Rao is a hospitalist at Denver Health Medical Center and an assistant professor of medicine at the University of Colorado at Denver, Aurora.

Clinical question: Does pharmacist-led medication reconciliation in the community after hospital discharge reduce health care utilization, readmission rates, ED visits, primary care visits, or primary care workload?

Background: Accurate medication reconciliation is essential to ensure safe transitions of care after hospital discharge. Studies have shown that harm from prescribed or omitted medications is higher after discharge and pharmacist-led medication reconciliation on discharge has been shown to improve clinical outcomes. The effect of medication reconciliation after discharge performed by primary care and community-based pharmacist is unclear.

Study design: A meta-analysis.

Setting: This meta-analysis included five randomized, controlled trials, six cohort studies, two pre- and postintervention studies performed in the United Kingdom and United States as well as one quality improvement project performed in Canada.

Synopsis: The studies included demonstrated that community-based pharmacists were more effective at identifying and resolving discrepancies, compared with usual care, but the clinical relevance was unclear. There was no evidence that this reduced readmission rates. Because of the the heterogeneity of the settings, methods, and data reporting in the included trials, no firm conclusion could be drawn regarding the impact on either ED visits and primary care burden, and no consistent evidence of benefit was found. The benefit in clinical outcomes seen in prior studies may be related to other interventions, including patient education, medication review, and improved communication with primary care physicians. This study aimed to specifically isolate the impact of postdischarge, pharmacist-led medication reconciliation, and further research is still needed to understand the clinical relevance of medication discrepancies and which pharmacist-led interventions are most important.

Bottom line: Community-based pharmacists can identify and resolve discrepancies while performing medication reconciliation after hospital discharge, but there is no conclusive benefit in clinical outcomes, such as readmission rates, health care utilization, and primary care visits.

Citation: McNab D et al. Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge. BMJ Qual Saf. 2017 Dec 16. pii: bmjqs-2017-007087. doi: 10.1136/bmjqs-2017-007087.

Dr. Rao is a hospitalist at Denver Health Medical Center and an assistant professor of medicine at the University of Colorado at Denver, Aurora.