Department of Clinical and Pharmacy Practice, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.
Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, United Kingdom.
PLoS One. 2018 Mar 28;13(3):e0193510. doi: 10.1371/journal.pone.0193510. eCollection 2018.
Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events.
To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only.
Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model.
From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable.
Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.
药物不良事件（ADEs）给急性医院服务带来了重大的临床和成本负担。据报道，药剂师提供的用药核对服务可有效降低因药物不良事件导致的住院几率。
通过仅限制随机对照试验（RCTs）来更新之前对药剂师主导的用药核对的评估。
截至 2016 年 12 月 30 日，我们在六个主要在线数据库（Embase、Medline Ovid、PubMed、BioMed Central、Web of Science 和 Scopus）中进行筛选，以评估药剂师主导的干预措施对用药差异、可预防的药物不良事件、潜在的药物不良事件和医疗保健利用的影响。我们应用 Cochrane 工具来评估偏倚的可能性。采用随机效应模型进行荟萃分析。
从最初的搜索中确定了 720 篇文章，纳入了 18 项 RCT（6038 名患者）。纳入研究的质量各不相同。药剂师主导的干预措施显著降低了药物差异，合并风险比为 42%（RR 0.58；95% CI 0.49 至 0.67；P<0.00001）。干预组的医疗保健利用率降低了 22%（RR 0.78；95% CI 0.61 至 1.00；P=0.05），潜在 ADEs 减少了 10%（RR 0.90；95% CI 0.78 至 1.03；P=0.65），可预防的 ADEs 减少了 27%（RR 0.73；0.22 至 2.40；P=0.60），但差异无统计学意义。
药剂师主导的干预措施可有效减少用药差异。然而，这些干预措施并未显著降低潜在和可预防的 ADEs 以及医疗保健利用。
