- Design
- Mixed-methods systematic review with random-effects meta-analysis
- Population
- 70 studies of medication reconciliation at care transitions vs usual care
- Primary outcome
- Discrepancies, adverse drug events, readmissions, ED visits
- Effect
- Discrepancies RR 0.39 (0.28–0.53); 30-day readmissions RR 0.73 (0.68–0.78); ADEs RR 0.61 (0.47–0.79)
A mixed-methods systematic review in the Journal of General Internal Medicine included 70 studies of medication reconciliation at care transitions against usual care, and identified 20 distinct components of reconciliation protocols.
Reconciliation lowered medication discrepancies (RR 0.39), adverse drug events (RR 0.61), 30-day all-cause readmissions (RR 0.73), emergency department visits (RR 0.60) and drug-related readmissions (RR 0.51). Pharmacist-led programmes and reconciliation performed at admission were the most effective; reconciliation on admission was the single strongest component.
Most errors in hospital prescribing start with an incomplete list at the door. For a physician carrying multimorbid, polypharmacy patients, a structured best-possible medication history on admission is the cheapest safety intervention available. In Indian hospitals, where patients bring loose strips and prescriptions from several doctors, the gap is often wider.
- Take a structured medication history at admission from at least two sources — patient, carer, strips, prescriptions or pharmacy.
- Involve a pharmacist in reconciliation where one is available.
- Record what was stopped, changed or started, and why, at each transition.
- Reconcile again at discharge and hand a clear list to the patient and their next doctor.
- Ask specifically about over-the-counter, herbal and Ayurvedic products.
Why it matters
A quarter fewer readmissions from a process most wards already claim to do, but do inconsistently.
Don't overread it
The included studies varied widely in design and quality, and many were not randomised.
The statistics, in plain English
An RR of 0.73 for readmissions means about 27% fewer, with an interval of 0.68–0.78 well clear of 1. Pooling 70 mixed studies gives a consistent direction, but the exact size will vary with local practice.
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