title: Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study.
abstract: The 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.
  
  
  
  Patients 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.
  
  
  
  200 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.
  
  
  
  The 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.
  
  
  
  ISRCTN23949491.
authors.affiliation: Pharmacy Department, Cambridge University Hospitals, Cambridge, UK.
authors.forename: Brit
authors.initials: B
authors.lastname: Cadman
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: Pharmacy Department, Cambridge University Hospitals, Cambridge, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bale
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.|Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
authors.forename: Garry
authors.initials: G
authors.lastname: Barton
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich, UK.
authors.forename: James
authors.initials: J
authors.lastname: Desborough
authors.affiliation: School of Pharmacy, University of Jordan, Jordan.
authors.forename: Eman A
authors.initials: EA
authors.lastname: Hammad
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
authors.affiliation: Pharmacy Department, Cambridge University Hospitals, Cambridge, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Howe
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Nunney
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.|Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Irvine
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D061214:Patient Safety / Q000191:economics / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000191:economics*; D010865:Pilot Projects; D006113:United Kingdom
keywords: cost-effectiveness; medicines reconciliation; pharmacy; pilot study; randomized controlled trial