title: Impact of medication reconciliation and review on clinical outcomes.
abstract: OBJECTIVE
  To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities.
  
  
  METHODS
  This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014.
  
  
  METHODS
  Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form.
  
  
  RESULTS
  Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality.
  
  
  CONCLUSIONS
  The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia e.lehnbom@unsw.edu.au.
authors.forename: Elin C
authors.initials: EC
authors.lastname: Lehnbom
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stewart
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D059065:Medication Reconciliation; D009026:Mortality; D009735:Nursing Homes / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: clinical outcomes; medication reconciliation; medication review; systematic review