Table 1.

Timing and Components of Interventions

First Author, Yr (Study Design)	N	Timing of Intervention					Components of Intervention						Control Group	1 USPSTF Quality Rating
		Pre-Admission	Admission	During Hospitalization	Discharge	Post-Discharge	Medication History Taking	Medication Reconciliation	Patient Counseling	Communication with Outpatient Providers	Review Appropriateness of Medications	Post-discharge Communication with Patient
PHARMACIST-RELATED INTERVENTIONS
Michels, 2003 (Pre-Post)	NR	√	√				√	√					Usual care prior to intervention (nurse or physician recorded home medication list which was used for admission orders)	POOR
Bolas, 2004 (RCT)	162		√	√	√		√	√	√	√			Usual care (standard clinical pharmacy service which did not routinely perform discharge counseling)	POOR
Nickerson, 2005 (RCT)	253				√			√	√	√	√		Usual care (nurse performed discharge counseling and transcribed discharge note from medical record)	FAIR
Schnipper, 2006 (RCT)	176				√			√	√	√		√	Usual care (ward-based pharmacist performed routine review of medication orders, nurse performed discharge counseling)	GOOD
Kwan, 2007 (RCT)	464		√				√	√					Usual care (nurse conducted medication history and surgeon generated post-operative medication orders)	FAIR
Bergkvist, 2009 (Pre-Post)	115		√	√	√			√	√		√		Usual care prior to intervention (standard care without pharmacist involvement in reconciliation or review of medications on admission or discharge)	FAIR
Gillespie, 2009 (RCT)	400		√	√	√	√	√	√	√	√		√	Usual care (standard care without direct involvement of pharmacists at the ward level)	GOOD
Koehler, 2009 (RCT)	41		√	√	√	√	√	√	√	√	√	√	Usual care (floor nursing staff performed medication reconciliation and medication education)	FAIR
Vasileff, 2009 (2 Non-RCT)	74		√				√	√					Usual care (physician obtained medication history from patient and generated orders)	POOR
Walker, 2009 (2 Non-RCT)	724				√	√		√	√	√	√	√	Usual care (nurses provided patients with printed list of medications and instructions at discharge; Medicare beneficiaries received phone call 72 hours post-discharge)	FAIR
Eggink, 2010 (RCT)	85				√			√	√	√			Usual care (nurses provided verbal and written instructions at discharge, physician provided patient with medication list to give to their primary care physician)	GOOD
Lisby, 2010 (RCT)	99		√				√	√			√		Usual care (medication review by junior physician on admission, and by senior physician within 24 hours of admission)	GOOD
Mills, 2010 (Pre-Post)	100	√	√				√	√					Usual care (Admitting junior physician obtained medication history and reconciled medications when patient arrived on ward from the ER)	POOR
Hellstrom, 2011 (Pre-Post)	210		√	√			√	√			√		Usual care (standard care without pharmacist involvement in medication reconciliation on admission or during hospitalization, standard physician performed medication reconciliation on discharge)	POOR
3 Marotti, 2011 (RCT)	357	√	√				√	√					Usual care (medication history taking and prescribing performed by physician on admission)	POOR
IT INTERVENTIONS							Components
Poole, 2006 (Pre-Post)	100				√		Formation of a medication list from pre-existing electronic sources Reconciliation of discharge medications with this list						Usual care prior to intervention (patients discharged without use of a discharge medication worksheet)	POOR
Agrawal, 2009 (Pre-Post)	NR		√				Formation of a medication list from pre-existing electronic sources Reconciliation of admission orders with this list						3 Usual care during pilot phase (standard care without use of electronic medication reconciliation system)	POOR
Murphy, 2009 (Pre-Post)	NR		√		√		Pharmacist performed medication history and reconciliation on admission Formation of a medication list from pre-existing electronic sources Reconciliation of discharge medications with this list						Usual care prior to intervention (standard care without direct involvement of pharmacist on ward level and without electronic reconciliation)	POOR
Schnipper, 2009 (RCT)	322		√		√		Formation of a medication list from pre-existing electronic sources Reconciliation of admission orders and discharge medications with this list Pharmacist confirmation of reconciliation at admission						Usual care (ward-based pharmacist performed routine review of medication orders, nurse performed discharge counseling)	GOOD
Boockvar, 2011 (2 Non-RCT)	795		√				Formation of a medication list from pre-existing electronic sources Reconciliation of admission orders with this list						Usual care (no computerized availability of recent VA outpatient medication use)	POOR
Showalter, 2011 (Pre-Post)	34088				√		Formation of a medication list from pre-existing electronic sources Reconciliation of discharge medications with this list						Usual care prior to intervention (manual completion of a printed medication reconciliation document)	GOOD
OTHER INTERVENTIONS							Components
Varkey, 2007 (Pre-Post)	102		√	√	√		Multidisciplinary medication reconciliation with use of reconciliation form on admission and discharge Education of staff on medication reconciliation including real-time feedback on detected medication discrepancies						Usual care during “Phase I” (nurses, pharmacists and physicians used a medication reconciliation form to collect and reconcile medications at admission and discharge, but no feedback was given)	POOR
Midlov, 2008 (Pre-Post)	427				√		Use of a physician generated medication report to next provider of care at time of discharge that includes details of medication changes made during hospital course						Usual care prior to intervention (no structured way that medication changes were communicated to outpatient providers)	POOR
Chan, 2010 (Pre-Post)	407		√				Multidisciplinary medication history and reconciliation on admission Education of health care providers on importance of medication reconciliation via lectures, posters around hospital, and reminder notes in patient charts						Usual care prior to intervention (pharmacist performed medication history on small number of patients; this did not change during the study)	POOR
Tessier, 2010 (Pre-Post)	100		√				Nursing performed medication reconciliation with use of a 6-step instructional pamphlet						Usual care prior to intervention (not described)	POOR
De Winter, 2011 (Pre-Post)	260	√					ED physician performed medication history taking and reconciliation with use of a standardized “limited questions list” questionnaire						Usual care (admitting physician performed medication history taking and reconciliation without use of a standardized tool)	POOR

Abbreviations: IT = Information Technology; RCT = Randomized Controlled Trial; Non-RCT = Non-Randomized Controlled Trial; NR = Not Reported

¹USPSTF = U.S. Preventive Services Task Force, utilizing set criteria for assessing internal validity of individual studies. Please email corresponding author for further details on how quality ratings were assigned.

²Non-RCT had a concurrent control group, but the sample was a convenience sample as opposed to a randomized sample

³Given poor compliance during pilot phase, comparison group was reflective of usual care prior to intervention