Table 3

Identification, resolution and clinical relevance of discrepancies and reported healthcare utilisation

Study designStudyRisk of biasDiscrepancy resolutionClinical relevance of discrepanciesHealthcare utilisation
RCTNazareth et al 22 LowNot evaluatedNot evaluatedNo statistically significant effect on readmission rate or GP attendance at 3 and 6 months
Hospital readmission at 3 months:
Intervention=64/164 (39.0%)
Control=69/176 (39.2%)
Hospital readmission between 3 and 6 months:
Intervention=38/136 (27.9%)
Control=43/151 (28.4%)
Mean pharmacist time per visit:
Journey time 17 min, visit time 38 min, admin time 32 min (total 1 hour 27 min)
Holland et al 17 LowNot evaluatedNot evaluatedIncreased readmission rate at 6 months by 30%
Total number admission over 6 months:
Intervention=234/429 (54.5%)
Control=178/426 (41.8%)
Increased need for GP home visit by 43%
Intervention=204 visits
Control=125 visits
Rate ratio 1.41, P=0.002
Ho et al 23 ModerateNot evaluatedNot evaluatedNo statistically significant reduction in readmission rate for revascularisation or for myocardial infarction at 12 months
Control=26/119 (21.8%)
Mean pharmacist time 3 hours 51 min
Duggan et al 24 ModerateRemaining unintentional discrepancy rate (per drug prescribed):
Control=700/1328 (52.7%)
Intervention=454/1408 (32.2%)
Consensus panel judged to have possible adverse effects:
Intervention=51/1408 (3.6%)
Control=83/1328 (6.3%)
Definite adverse effect:
Intervention=23/1408 (1.6%)
Control 41/1328 (3.1%)
Absolute risk reduction 5.3%
Number Needed to Treat=19
Not evaluated
Hawes et al 25 ModerateIncreased discrepancy resolution rate per patient:
Intervention=6/12 (50%)
Control=2/21 (9.5%)
Type of discrepancy reported not clinical relevanceReduced readmission rate at 30 days
Intervention=0/24 (0%)
Control=12/37 (40.5%)
Reduced emergency department attendance at 30 days
Intervention=0/24 (0%)
Control=11/37 (29.7%)
CohortShcherbakova et al 26 ModeratePharmacist identified 301 medication-related problems in 156 patients=mean 1.93 per patient
No figures reported for control group
Type of discrepancy reported not clinical relevanceNo statistically significant effect on readmission rate at 30 days
Intervention=16/156 (10.3%)
Control=6/89 (6.7%)
No statistically significant difference in emergency department attendance at 30 days
Intervention=34/156 (21.8%)
Control=13/89 (14.6%)
Kilcup et al 27 ModeratePharmacist resolved discrepancies present in >80% of patients (exact figures not given).
Data on control group not measured and reported
Type of discrepancy reported not clinical relevanceReduction of readmission at 7 days and 14 days but not statistically significant at 30 days
30-day readmission rate:
Intervention=28/243 (11.5%)
Control=34/251 (13.5%) (P=0.29)
Setter et al 28 ModerateIncreased resolution rate:
Intervention=154/220 (70%)
Control=139/231 (60%)
Discrepancies classified as patient or system factors and not by clinical relevanceReduced number of days admitted to hospital per patient in intervention group
Reduced planned physician visits:
Reduced unplanned physician visit:
Tedesco et al 30 ModerateNot evaluatedNot evaluatedReadmission 30 days
Intervention=5/34 (14.7%)
Control=12/45 (26.7%)
Polinski et al 31 HighDiscrepancy rate not reportedState 88 of 131 (67%) of medication reconciliation an omission of a prehospital medication or an identified gap based on clinical guidelines was identified
Drug–drug interactions present in 21 of 131 (16%) of cases—no comment on severity
Reduced 30 day readmission rate
Intervention group=16/131 (12.2%)
Control group=29/131 (22.1%)
Risk ratio (95% CI)=0.5 (0.29 to 0.88)
Zeitouni et al 33 HighNot reportedNot reportedReduction in readmission at 1 month:
Pre/post intervention studiesBoockvar et al 29 ModerateFound 696 discrepancies following 259 discharges=2.69 per patient (not measured in preintervention phase)Calculated a drug discrepancy risk index; where this was raised, two reviewers reviewed notes to determine if possible discrepancy related adverse drug event:
Postintervention=1/43 (2.3%)
Preintervention=10/69 (14.5%)
No figures reported but state no difference in readmission rate
Physician responded to discrepancies:
Awareness of discrepancy=429/598 (71.7%)
Intention to review=41/598 (6.9%)
Intention to adjust regimen=49/598 (8.2%)
Intention to increase monitoring=23/598 (3.8%)
Gray et al 32 HighIncreased resolution rate
Intervention=33 plans implemented out of 41 (80.5%)
Control=23 plans implemented out of 45 (51%)
Examples of discrepancy listed but not quantifiedNot evaluated
Vuong et al 34 HighNo preintervention data presented
Mean discrepancy rate of 2 per medication reconciliation reported postintervention
No preintervention data presented
Mean number of clinical concerns per medication reconciliation postintervention=6
90-day readmission and emergency department attendance rate—no difference preintervention and postintervention; remained at median of 13% for each cohort
Freed up 3 hours of nursing time and 1 hour physician time
Consulted with pharmacist for 2 hours
  • GP, general practitioner or primary care physician.