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. 2021 Nov 25;2021(11):CD009985. doi: 10.1002/14651858.CD009985.pub2

Pevnick 2018.

Study characteristics
Methods RCT.
This was a three‐arm randomised controlled trial of 306 inpatients. In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians, obtained initial admission medication history (AMHs) prior to admission.
Unit of allocation: patients
Unit of analysis: patients
Participants Eligible participants were medically complex patients admitted to CSMC through the ED (N=306).
IP adults (medical and surgical wards)
Interventions Medication reconciliation, Clinical pharmacy services
Patients were randomly allocated to usual care or to one of two intervention arms in which either a pharmacist or a pharmacist‐supervised pharmacy technician (PSPT) had primary responsibility for obtaining the AMH.
Intervention 1: pharmacist
Intervention 2: PSPT (pharmacist‐supervised pharmacy technician)
Control: usual care
Outcomes The primary outcome was severity‐weighted mean admission medication history (AMH) error score
Notes Trial registration number NCT02026453
Funding: Joshua Pevnick was supported by the National Institute On Aging and the National Center for Advancing Translational Science of the National Institutes of Health under awards K23AG049181 and UCLA CTSI KL2TR000122
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk "After enrolling patients meeting criteria, investigators used RANDI2 randomisation software to randomise each patient."
Allocation concealment (selection bias) High risk "Each block of six consecutively enrolled patients was allocated in a 2:2:2 distribution across the three study arms"
"(...) not all aspects of randomisation were masked from study personnel. Because block size was not masked, selection bias could have occurred."
Blinding of participants and personnel (performance bias)
All outcomes Low risk No blinding but the outcome is not likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias)
All outcomes Low risk "In obtaining reference standard AMHs, expert pharmacists identified AMH errors in the initial AMHs and classified each error according to a previously developed taxonomy as significant, serious or life threatening." "A second pharmacist reviewed classifications, and a physician adjudicated disagreements."
Incomplete outcome data (attrition bias)
All outcomes High risk The primary outcome was not measurable for 9/103 (8.7%) participants receiving pharmacist AMH. 14/102 (13.7%) participants receiving PSPT AMH, and 6/102 (5.9%) patients receiving usual care, with a total of 28/306 (9.2%) patients lacking a reference standard AMH. Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups.
Selective reporting (reporting bias) Low risk The study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were prespecified in the clinical trial registry.
Conflict of interest Unclear risk JP currently receives funding from the American Society for Health‐System Pharmacists Research and Education Foundation to design a toolkit for pharmacists to use in post‐discharge medication management.
Other bias Low risk No other sources of bias were detected.