Pharmacy led medicine reconciliation at hospital: A systematic review of effects and costs

Hammad, Eman A.; Bale, Amanda J; Wright, David; Bhattacharya, Debi

doi:10.1016/j.sapharm.2016.04.007

Cited by 42 publications

(45 citation statements)

References 37 publications

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“…Hammad et al ,22 in their systematic review of studies of ‘complete MR’ (on admission and through to discharge) also found scant published evidence of the cost-effectiveness of pharmacy-led MR.…”

Section: Discussionmentioning

confidence: 99%

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Economic value of pharmacy-led medicines reconciliation at admission to hospital: an observational, UK-based study

Onatade

Quaye

2016

Eur J Hosp Pharm

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ObjectiveTo describe the cost–benefits of pharmacy-led medicines reconciliation (MR) on admission by applying a theoretical model (University of Sheffield School of Health and Related Research—SCHARR model) to real-world data.MethodsThis was a retrospective, single-centre study. Setting 1000-bedded teaching hospital in London, UK. Clinical pharmacy contributions related to unintended medication discrepancies (averted preventable adverse drug events, pADEs), documented by pharmacy staff on prearranged days during 2012, were assessed for clinical significance by a panel of senior clinical pharmacists using the SCHARR model. Costs avoided were allocated according to the SCHARR model. Pharmacy staff carrying out admission MR were timed. Net cost avoidance was calculated by subtracting cost of time taken to carry out MR from the costs avoided by averting pADEs. Sensitivity analyses were carried out.Results118 pADEs averted as a result of MR were recorded over the 6 reporting days. 116 were rated for clinical significance. Gross costs avoided were £36 135–£75 249 (€44 446–€92 556). The admission MR process was timed for 48 patients. The mean time to complete MR for one patient was 14 min (range 1–40 min). The cost of carrying out one MR, based on the cost of employing a first-level post-foundation clinical pharmacist was £7.56 (€9.30). The net benefit of one MR was £34–£80 (€42–€98). The benefit:cost ratio was 5.53:1–11.51:1.ConclusionsPharmacy-led MR on admission has significant economic, as well as clinical benefits. Further work is required for full economic evaluations of MR.

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Section: Discussionmentioning

confidence: 99%

“…At 6 months postdischarge, the savings in medication costs outweighed staff costs. A systematic review of effects and costs of pharmacy-led MR22 could not come to a definite conclusion on the effects and costs. Both studies combined admission and discharge MR.…”

Section: Introductionmentioning

confidence: 97%

Economic value of pharmacy-led medicines reconciliation at admission to hospital: an observational, UK-based study

Onatade

Quaye

2016

Eur J Hosp Pharm

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“…There is currently a recognised lack of evidence supporting the cost-effectiveness of MR interventions provided by pharmacists 16. A model built in 2008 to estimate the likely cost-effectiveness of preventing medication error at hospital admission using MR suggested that a pharmacist-based intervention is likely to be cost-effective but was based solely on US error data and made assumptions concerning the severity of errors prevented 17…”

Section: Introductionmentioning

confidence: 99%

Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study

et al. 2017

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BackgroundThe UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken.MethodPatients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined.Result200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates.ConclusionsThe results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.Trial registration numberISRCTN23949491.

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“…The risk of adverse drug events increases with insufficient pharmacological knowledge of healthcare professionals, documentation errors in patient records and limited pharmacy service in the clinic . To mitigate this, clinical pharmacy services targeting different situations in the hospital setting have been developed and evaluated during the last decades .…”

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confidence: 99%

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Skjøt‐Arkil

Lundby

Kjeldsen³

et al. 2018

Basic Clin Pharma Tox

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Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

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Pharmacy led medicine reconciliation at hospital: A systematic review of effects and costs

Abstract: 1Background: Transition of patients care between settings presents an increased opportunity

Cited by 42 publications

References 37 publications

Economic value of pharmacy-led medicines reconciliation at admission to hospital: an observational, UK-based study

Economic value of pharmacy-led medicines reconciliation at admission to hospital: an observational, UK-based study

Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

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