Table 3.
Identification, resolution and clinical relevance of discrepancies and reported healthcare utilisation
| Study design | Study | Risk of bias | Discrepancy resolution | Clinical relevance of discrepancies | Healthcare utilisation |
| RCT | Nazareth et al 22 | Low | Not evaluated | Not evaluated | No statistically significant effect on readmission rate or GP attendance at 3 and 6 months Hospital readmission at 3 months: Intervention=64/164 (39.0%) Control=69/176 (39.2%) Hospital readmission between 3 and 6 months: Intervention=38/136 (27.9%) Control=43/151 (28.4%) Mean pharmacist time per visit: Journey time 17 min, visit time 38 min, admin time 32 min (total 1 hour 27 min) |
| Holland et al 17 | Low | Not evaluated | Not evaluated | Increased readmission rate at 6 months by 30% Total number admission over 6 months: Intervention=234/429 (54.5%) Control=178/426 (41.8%) Increased need for GP home visit by 43% Intervention=204 visits Control=125 visits Rate ratio 1.41, P=0.002 |
|
| Ho et al 23 | Moderate | Not evaluated | Not evaluated | No statistically significant reduction in readmission rate for revascularisation or for myocardial infarction at 12 months Intervention=22/122(18.0%) Control=26/119 (21.8%) Mean pharmacist time 3 hours 51 min |
|
| Duggan et al 24 | Moderate | Remaining unintentional discrepancy rate (per drug prescribed): Control=700/1328 (52.7%) Intervention=454/1408 (32.2%) |
Consensus panel judged to have possible adverse effects: Intervention=51/1408 (3.6%) Control=83/1328 (6.3%) Definite adverse effect: Intervention=23/1408 (1.6%) Control 41/1328 (3.1%) Absolute risk reduction 5.3% Number Needed to Treat=19 |
Not evaluated | |
| Hawes et al 25 | Moderate | Increased discrepancy resolution rate per patient: Intervention=6/12 (50%) Control=2/21 (9.5%) |
Type of discrepancy reported not clinical relevance | Reduced readmission rate at 30 days Intervention=0/24 (0%) Control=12/37 (40.5%) Reduced emergency department attendance at 30 days Intervention=0/24 (0%) Control=11/37 (29.7%) |
|
| Cohort | Shcherbakova et al 26 | Moderate | Pharmacist identified 301 medication-related problems in 156 patients=mean 1.93 per patient No figures reported for control group |
Type of discrepancy reported not clinical relevance | No statistically significant effect on readmission rate at 30 days Intervention=16/156 (10.3%) Control=6/89 (6.7%) No statistically significant difference in emergency department attendance at 30 days Intervention=34/156 (21.8%) Control=13/89 (14.6%) |
| Kilcup et al 27 | Moderate | Pharmacist resolved discrepancies present in >80% of patients (exact figures not given). Data on control group not measured and reported |
Type of discrepancy reported not clinical relevance | Reduction of readmission at 7 days and 14 days but not statistically significant at 30 days 30-day readmission rate: Intervention=28/243 (11.5%) Control=34/251 (13.5%) (P=0.29) |
|
| Setter et al 28 | Moderate | Increased resolution rate: Intervention=154/220 (70%) Control=139/231 (60%) |
Discrepancies classified as patient or system factors and not by clinical relevance | Reduced number of days admitted to hospital per patient in intervention group Intervention=0.4±1.2 Control=1.1±4.2 Reduced planned physician visits: Intervention=2.9±1.5 Control=3.5±2.7 Reduced unplanned physician visit: Intervention=0.2±0.6 Control=0.4±1.0 |
|
| Tedesco et al 30 | Moderate | Not evaluated | Not evaluated | Readmission 30 days Intervention=5/34 (14.7%) Control=12/45 (26.7%) P=0.27 |
|
| Polinski et al 31 | High | Discrepancy rate not reported | State 88 of 131 (67%) of medication reconciliation an omission of a prehospital medication or an identified gap based on clinical guidelines was identified Drug–drug interactions present in 21 of 131 (16%) of cases—no comment on severity |
Reduced 30 day readmission rate Intervention group=16/131 (12.2%) Control group=29/131 (22.1%) Risk ratio (95% CI)=0.5 (0.29 to 0.88) |
|
| Zeitouni et al 33 | High | Not reported | Not reported | Reduction in readmission at 1 month: Intervention=27% Control=45% |
|
| Pre/post intervention studies | Boockvar et al 29 | Moderate | Found 696 discrepancies following 259 discharges=2.69 per patient (not measured in preintervention phase) | Calculated a drug discrepancy risk index; where this was raised, two reviewers reviewed notes to determine if possible discrepancy related adverse drug event: Postintervention=1/43 (2.3%) Preintervention=10/69 (14.5%) |
No figures reported but state no difference in readmission rate Physician responded to discrepancies: Awareness of discrepancy=429/598 (71.7%) Intention to review=41/598 (6.9%) Intention to adjust regimen=49/598 (8.2%) Intention to increase monitoring=23/598 (3.8%) |
| Gray et al 32 | High | Increased resolution rate Intervention=33 plans implemented out of 41 (80.5%) Control=23 plans implemented out of 45 (51%) |
Examples of discrepancy listed but not quantified | Not evaluated | |
| Vuong et al 34 | High | No preintervention data presented Mean discrepancy rate of 2 per medication reconciliation reported postintervention |
No preintervention data presented Mean number of clinical concerns per medication reconciliation postintervention=6 |
90-day readmission and emergency department attendance rate—no difference preintervention and postintervention; remained at median of 13% for each cohort Freed up 3 hours of nursing time and 1 hour physician time Consulted with pharmacist for 2 hours |
GP, general practitioner or primary care physician.