Article Text

Download PDFPDF

Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge
  1. Duncan McNab1,2,
  2. Paul Bowie1,2,
  3. Alastair Ross3,
  4. Gordon MacWalter1,
  5. Martin Ryan1,
  6. Jill Morrison2
  1. 1 Medical Directorate, NHS Education for Scotland, Glasgow, UK
  2. 2 Institute of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
  3. 3 Dental School, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Duncan McNab, Medical Directorate, NHS Education for Scotland, Glasgow G3 8BW, UK; duncan.mcnab{at}


Background Pharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.

Methods This is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.

Results Fourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre–post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.

Conclusions Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.

  • medication reconciliation
  • pharmacists
  • primary care
  • transitions in care

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:

View Full Text

Statistics from


  • Contributors DM and MR performed title, abstract and full-text screening. All authors discussed disagreements to reach consensus. DM extracted data from all included studies. A second data extraction was completed independently for each included study. This was divided evenly between PB, AR, GM and JM. All authors reviewed and contributed to writing the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Search syntax for all databases and all versions of citation lists are available from DM.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.