Key result
Pharmacist-completed medication reconciliation identified an average of 2.46 discrepancies per patient and was associated with a 30-day readmission rate of 5.3% vs 19.5% in controls (P=0.054).
Why the study?
Does a pharmacy-driven medication reconciliation identify medication discrepancies and reduce 30-day readmissions in adult patients following hospital discharge?
Cohort (n=79)
No
Does a pharmacy-driven medication reconciliation identify medication discrepancies and reduce 30-day readmissions in adult patients following hospital discharge?
Pharmacist-led medication reconciliation following hospital discharge effectively identifies and resolves medication discrepancies and may trend toward reducing 30-day hospital readmissions.
Associated with fewer readmissions; leaves open a causal benefit pending randomized trials.
Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies. Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified. Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board. Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group ( P = .054). Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.
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Stauffer et al. (2020) conducted a cohort in Hospital discharge (n=79). Pharmacist-completed medication reconciliation vs. No pharmacist-completed medication reconciliation was evaluated on number of medication discrepancies identified during medication reconciliation. Pharmacist-completed medication reconciliation identified an average of 2.46 discrepancies per patient and was associated with a 30-day readmission rate of 5.3% vs 19.5% in controls (P=0.054).
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