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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Medication reconciliation during the transition to and from long-term care settings: a systematic review

PT Chhabra, GB Rattinger, SK Dutcher, ME Hare, KL Parsons, and IH Zuckerman.

Review published: 2012.

Link to full article: [Journal publisher]

CRD summary

The review concluded that a limited number of studies evaluated medication reconciliation involving long-term care settings and those that were identified had methodological flaws which limited the ability to draw conclusions about the effectiveness of the interventions. The review was generally well conducted. The authors' conclusions were based on the evidence and seem suitably cautious.

Authors' objectives

To evaluate studies performing medication reconciliation interventions in patients transferred to and from long-term care settings.

Searching

Cochrane Database of Systematic Reviews, PubMed, HealthStar and CINAHL were searched to August 2010 for articles in English. Search terms were reported. Reports from the Agency for Healthcare Research and Quality were searched. Reference lists of relevant reviews and included studies were searched.

Study selection

Experimental or quasi-experimental studies that evaluated an intervention involving medication reconciliation in patients transferred to and/or from long-term care settings were eligible for inclusion. Studies without a comparator group were excluded. Studies that involved transitions to or from home health agencies were excluded, as were non empirical studies. Studies published before 2000 were excluded.

The included studies considered: discharge from hospital to nursing home; discharge from skilled nursing facility to home; home or assisted living to hospital with discharge to various settings; hospital admission and hospital discharge to nursing home or home; various settings to hospital admission; first-time discharge from hospital to long term care facilities. The interventions predominantly involved pharmacy-managed or assisted medication reconcilement. Studies were conducted in USA, Sweden, Belgium and Australia. Mean ages of patients ranged from 69 to 84.4 years.

Two reviewers undertook study selection. Consensus between three or more reviewers was needed for study inclusion.

Assessment of study quality

No formal quality assessment was undertaken. Quality issues such as randomisation and selection bias were considered. Four reviewers independently extracted quality factors.

Data extraction

Data were extracted on medication discrepancy outcomes and other health outcomes. Four reviewers independently extracted the data. Trial authors were contacted for missing data.

Methods of synthesis

A narrative synthesis was presented.

Results of the review

Seven studies were included in the review (1,452 patients, range 41 to 521 patients). The authors noted that all of the studies were prone to biases.

All of the studies found some lower risks with the intervention using a variety of outcome measures. Reported outcomes included a 89% lower risk of a drug discrepancy related adverse event (one study), a 78% lower risk of death (one study), significantly improved quality of prescribing (one study) and a 10.7% increase in the number of patients transferred to nursing homes without medication errors (one study). One study showed a protective effect against worsening pain and hospital usage with the intervention. However, one study had higher mean cumulative ambulatory care visits at 60 days after discharge with intervention. One study had a longer length of hospital stay with the intervention.

Authors' conclusions

A limited number of studies evaluated medication reconciliation in long-term care settings and those that were identified had methodological flaws, which limited the ability to draw conclusions about the effectiveness of these interventions.

CRD commentary

Inclusion criteria for the review were clearly defined. Four relevant databases were searched. Only studies in English were included so there was a risk of language bias. Publication bias was not assessed and could not be ruled out. The authors noted that excluding studies published before 2000 may have introduced publication bias. Attempts were made to reduce reviewer error and bias throughout the review. Quality assessment was not undertaken using a standard checklist but the authors noted that all of the studies had biases. Data were narratively synthesised, which seemed appropriate given the differences across studies in terms of outcomes.

This review was generally well conducted. The authors' conclusions were based on the evidence and seem suitably cautious.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated a need for well-designed randomised studies to demonstrate the effectiveness of medication reconciliation interventions in long-term care settings. Interventions in different settings within the same study should be reported separately. Appropriate comparators should be used. Studies needed to have sufficient sample sizes.

Funding

Not stated.

Bibliographic details

Chhabra PT, Rattinger GB, Dutcher SK, Hare ME, Parsons KL, Zuckerman IH. Medication reconciliation during the transition to and from long-term care settings: a systematic review. Research in Social and Administrative Pharmacy 2012; 8(1): 60-75. [PubMed: 21511543]

Indexing Status

Subject indexing assigned by NLM

MeSH

Continuity of Patient Care; Humans; Long-Term Care; Medication Reconciliation; Patient Transfer

AccessionNumber

12012023277

Database entry date

06/02/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21511543

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