Pharmacy led medicine reconciliation at hospital: a systematic review of effects and costs

Eman A. Hammad, Amanda Bale, David J. Wright, Debi Bhattacharya

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Transition of patients care between settings presents an increased opportunity for errors and preventable morbidity. A number of studies outlined that pharmacy-led medication reconciliation (MR) might facilitate safer information transfer and medication use. MR practice is not well standardised and often delivered in combination with other healthcare activities. The question regarding the effects and costs of pharmacy-led MR and the optimum MR practice is warranted of value. 
To review the evidence for the effects and costs/ cost-effectiveness of complete pharmacy-led MR in hospital settings. 
A systematic review searching the following database was conducted up to the 13th December 2015; EMBASE & MEDLINE Ovid, CINAHL and the Cochrane library. Studies evaluating pharmacy-led MR performed fully from admission till discharges were included. Studies evaluated non-pharmacy-led MR at only one end of patient care or transfer were not included. Articles were screened and extracted independently by two investigators. Studies were divided into those in which: MR was the primary element of the intervention and labelled as “primarily MR” studies, or MR combined with non-MR care activities and labelled as “supplemented MR” studies. Quality assessment of studies was performed by independent reviewers using a pre-defined and validated tool. 
The literature search identified 4,065 citations, of which 13 implemented complete MR. The lack of evidence precluded addressing the effects and costs of MR. 
The composite of optimum MR practice is not widely standardised and requires discussion among health professions and key organisations. Research focused on evaluating cost-effectiveness of pharmacy-led MR is lacking. 
Original languageEnglish
Pages (from-to)300–312
JournalResearch in Social and Administrative Pharmacy
Issue number2
Early online date12 May 2016
Publication statusPublished - Mar 2017


  • medicine reconciliation
  • care transition errors
  • costs
  • hospital pharmacy
  • pharmacy-led medicine reconciliation

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