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Effectiveness Of Pharmacist-led Medication Reconciliation Programmes On Clinical Outcomes At Hospital Transitions: A Systematic Review And Meta-analysis

Authors : Alemayehu B Mekonnen, Andrew J McLachlan, Jo-anne E Brien


Objectives Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients’ clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions.

Design Systematic review and meta-analysis.


We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity.


17 studies involving 21 342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results.


Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.

Citation: Alemayehu B Mekonnen, Andrew J McLachlan, Jo-anne E Brien Effectiveness Of Pharmacist-led Medication Reconciliation Programmes On Clinical Outcomes At Hospital Transitions: A Systematic Review And Meta-analysis BMJ Open 2016;6:e010003 doi:10.1136/bmjopen-2015-010003

Received 17 September 2015 Revised 26 November 2015 Accepted 18 December 2015 Published 23 February 2016

Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:


ABM was responsible for the study conception and design, under the supervision of JEB. The literature search, abstract screening, study and data extraction were undertaken by ABM with further confirmation by JEB. ABM carried out the initial analysis and drafted the first manuscript. JEB and ABM critically reviewed and revised the manuscript. All the authors have read and approved the final manuscript as submitted.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.


The authors would like to acknowledge Asres Berhan for his comments on the data analysis and interpretation, and statistical advice on using the meta-analysis software. The authors would also like to acknowledge Lorraine Evison for her invaluable contributions in the electronic database searching and abstract screening.

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