Table 2.

Study Outcomes

First Author, Yr (Study Design)	* Outcomes Examined				Results	P value or OR [95% CI]
	Medication Discrepancies	Potential Adverse Drug Events (PADEs)	Adverse Drug Events (ADEs)	Healthcare Utilization
PHARMACIST-RELATED INTERVENTIONS
Michels, 2003 (Pre-Post)	+				Number of defects decreased from 1.45 per order form to 0.76 in first 16 weeks of implementation	<0.001
					Mean number of defects per individual drug order decreased from 0.25 to 0.12	<0.001
Bolas, 2004 (RCT)	+			~	Decrease in drug name mismatch at 10–14 days post-discharge	0.005
					Decrease in drug frequency mismatch at 10–14 days post-discharge	0.004
					No difference in emergency readmission rates within 3 months or LOS on readmission	>0.05
Nickerson, 2005 (RCT)	+				Medication discrepancies at time of discharge were noted in 56.3% of control patients versus 3.6% of intervention patients	NR
Schnipper, 2006 (RCT)			+	~	Preventable ADEs 11% in control group versus 1% in intervention group at 30 days post-discharge	0.01
					No difference in healthcare utiliza tion	>0.05
Kwan, 2007 (RCT)	+	+			40.2% of control patients had a post-op medication discrepancy versus 20.3% in intervention group	<0.001
					29.9% of control patients had a post-op medication discrepancy with potential for harm versus 12.9% in intervention group	<0.001
Bergkvist, 2009 (Pre-Post)	+				63.5% of control patients had at least one medication error versus 26.9% of intervention patients	0.012
Gillespie, 2009 (RCT)				+	Intervention group had 16% reduction in all hospital visits (quotient of 2.24 in control group versus 1.88 in intervention group) at 12 months follow up	0.84 [0.72–0.99]
					Intervention group had a 47% reduction in ED visits (quotient of 0.66 in control group versus 0.35 in intervention group) at 12 months follow up	0.53 [0.37–0.75]
					Intervention group had 80% reduction in drug-related readmissions at 12 months follow up	0.2 [0.1–0.41]
					No difference in all-cause readmissions, no difference in overall survival at 12 months follow up	>0.05
Koehler, 2009 (RCT)				+	38.1% of control group had readmission/ED visit at 30 days versus 10% in intervention group	0.04
					Readmission/ED visit at 60 days was same in 2 groups	>0.05
					Time to readmission/ED visit was 15.7 days in control group versus 36.2 days in intervention group	0.05
Vasileff, 2009 (Non-RCT)	+	+			75.6% of usual care patients had ≥ 1 unintentional discrepancy versus 3.3% of intervention patients	<0.05
					Of the unintentional discrepancies, 2% were felt to have potential for no harm, 40% had potential for minor impact, 52% had potential for significant impact, and 6% had potential for very significant impact	IRR < 0.8, except for one possible pairing (not specified)
Walker, 2009 (Non-RCT)	+			~	Medication discrepancies at discharge were noted in 59.6% of control patients versus 33.5% of intervention patients	<0.001
					No difference in 14-day or 30-day readmission rate, no difference in ED visits within 72 hours	>0.05
Eggink, 2010 (RCT)	+	~			Medication discrepancies at discharge were noted in 68% of control patients versus 39% of intervention patients	0.57 [0.37, 0.88]
					Of the medication discrepancies, 29% were felt to have potential for serious harm in the control group versus 32% in the intervention group	NR (stated in text “non-significant)
Lisby, 2010 (RCT)			~	~	No difference in length of stay, time to readmission, 3-month readmission, ED visits, visits to general practitioners, mortality	>0.05
Mills, 2010 (Pre-Post)	+				Medication errors decreased from 3.3 errors/patient pre-intervention to 0.04 errors/patient post-intervention	>0.05
Hellstrom, 2011 (Pre-Post)				~	No difference in drug-related healthcare utilization 3 months post-discharge	0.138
Marotti, 2011 (RCT)	+				Mean number of missed medication doses during hospitalization was 3.21 in control group versus 1.07 in intervention group	<0.001
IT INTERVENTIONS
Poole, 2006 (Pre-Post)	+				Resolution of medication discrepancies increased by 65%	<0.001
Agrawal, 2009 (Pre-Post)	+				Unintended discrepancy rate decreased from 20% per-intervention to 1.4% post-intervention	NR
Murphy, 2009 (Pre-Post)	+				Unintended medication discrepancies decreased from 90% to 47% on surgical floors, and from 57% to 33% on medical floors	0.001
Schnipper, 2009 (RCT)		+			Average number of PADEs per patient was 1.44 in the control group versus 1.05 in the intervention group	0.72 [0.52–0.99]
Boockvar, 2011 (Non-RCT)			+		Intervention group experienced 43% reduction in adverse drug events caused by admission prescribing changes classified as errors	0.57 [0.33, 0.98]
					No difference in adverse drug events caused by all admission prescribing changes	1.04 [0.68, 1.61]
Showalter, 2011 (Pre-Post)				~/−	No difference in composite outcome of 30-day readmission or ED visit from pre-intervention to post-intervention	0.17
					30-day readmission rate was 10.2% pre-intervention compared to 11% post-intervention	0.02
OTHER INTERVENTIONS
Varkey, 2007 (Pre-Post)	+				Mean number of medication discrepancies per patient at time of admission decreased from 0.5 pre-intervention to 0 post-intervention	0.018
					Mean number of medication discrepancies per patient at time of discharge decreased from 3.3 pre-intervention to 1.8 post-intervention	0.003
Midlov, 2008 (Pre-Post)		+			8.9% of control group had potential adverse drug events that would lead to required medical care (readmission to hospital or visit to PCP) compared with 4.4% of intervention group	0.049
Chan, 2010 (Pre-Post)	+	+			Unintentional medication discrepancy rate per admission decreased from 2.6 pre-intervention to 1.0 post-intervention	<0.001
					The proportion of admissions with one or more clinically significant unintentional medication discrepancies decreased from 46% pre-intervention to 24% post-intervention	0.023
Tessier, 2010 (Pre-Post)	+				Medication discrepancies were present in 42% of patients pre-intervention versus 20% of post-intervention patients	0.03
De Winter, 2011 (Pre-Post)	+				Mean number of medication discrepancies per patient was 1.1 in control group versus 0.6 in intervention group	<0.001

Abbreviations: LOS = length of stay; IRR = Inter-rater reliability; IT = information technology; ED = Emergency Department; PCP = Primary Care Physician; RCT = randomized controlled trial

^*Outcomes examined intervention versus “usual care” as the comparison group (detailed in Table 1) for all studies

⁺indicates statistically significant improvement with intervention versus control in at least one outcome in this category

^~indicates no statistically significant difference between intervention and control in at least one outcome in this category

⁻indicates statistically significant worsening with intervention versus control in at least one outcome in this category