Interventions to improve medication reconciliation in primary care.

Area of Science:

• Pharmacology
• Health Services Research
• Evidence-Based Medicine

Background:

• Medication reconciliation is a process to ensure accurate medication information for each patient.
• Primary care settings present unique challenges for implementing medication reconciliation.
• The effectiveness of medication reconciliation interventions in primary care requires systematic evaluation.

Purpose of the Study:

• To systematically review primary care intervention studies on medication reconciliation.
• To assess the impact of these interventions on medication discrepancies, clinical outcomes, and patient knowledge.
• To evaluate the quality of evidence for medication reconciliation in primary care.

Main Methods:

• Searched multiple databases (MEDLINE, Healthstar, CINAHL, EMBASE, Cochrane) and unpublished material from 1966 to March 2008.
• Included randomized controlled trials and before-and-after studies in ambulatory settings or at hospital discharge.
• Two independent reviewers assessed study inclusion and data abstraction, with good inter-rater agreement (Cohen's kappa = 0.71).

Main Results:

• Four trials met inclusion criteria; two in ambulatory care showed conflicting results on reducing medication discrepancies.
• One randomized controlled trial and one before-and-after study at hospital discharge found no benefit from pharmacist medication review.
• All included studies had significant design flaws, precluding data pooling due to heterogeneity.

Conclusions:

• Currently, there is a lack of high-quality evidence to support the effectiveness of medication reconciliation in primary care.
• Further rigorous research is necessary to establish the benefits of medication reconciliation in this setting.