Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
Res Social Adm Pharm. 2020 May;16(5):605-613. doi: 10.1016/j.sapharm.2019.08.001. Epub 2019 Aug 1.
One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge from hospital. However, there are divergences about this process and about the pharmacist's role in conducting such intervention.
To systematically review the literature that reports the MR process led by pharmacists at patient discharge and map the different methods, strategies and tools used in the process.
Relevant studies were searched in the following databases: EMBASE, MEDLINE (PubMed), The Cochrane Library, and LILACS. No language restriction or publication date was applied. The studies considered eligible were those involving and describing pharmacist-led MR processes at acute patient discharge from hospital, with an experimental, quasi-experimental, or observational design. The characteristics of the studies and the MR processes were identified and then a qualitative synthesis was performed.
Fifty studies were included. The majority of them were observational ones (82%), and the main outcome was medication discrepancies (42%). The studies were mostly conducted in university hospitals (70%) and in internal medicine wards (54%). Pharmacists were responsible mainly for gathering medication histories (72%), and identifying (96%) and solving (98%) pharmacotherapeutic problems. The main sources of information on pre-admission medications were patient/caregiver interviews (66%) and records from other care providers (40%). Only 30% of the studies described a patient discharge plan, and 14% shared information of the patient's pharmacotherapy with community pharmacists.
The concept of MR and the pharmacist-led activities in the process varied in the literature, as well as the pharmacotherapy assessment focus and the communication strategies towards patients and other care providers, showing that standardization of the process and concepts is necessary.
促进医疗交接过程中患者安全的策略之一是药物重整（MR），由药师在患者出院时进行。然而，关于这个过程以及药师在进行这种干预时的角色存在分歧。
系统回顾文献，报告药师在患者出院时进行的 MR 过程，并绘制该过程中使用的不同方法、策略和工具。
在以下数据库中搜索相关研究：EMBASE、MEDLINE（PubMed）、The Cochrane Library 和 LILACS。未应用语言限制或出版日期。纳入的研究为涉及并描述了在急性患者出院时由药师主导的 MR 过程，具有实验、准实验或观察性设计的研究。确定了研究的特征和 MR 过程，并进行了定性综合。
纳入了 50 项研究。其中大多数为观察性研究（82%），主要结局为药物差异（42%）。研究主要在大学医院（70%）和内科病房（54%）进行。药师主要负责收集用药史（72%）、识别（96%）和解决（98%）药物治疗问题。关于入院前用药的主要信息来源是患者/照顾者访谈（66%）和其他护理提供者的记录（40%）。只有 30%的研究描述了患者出院计划，14%的研究与社区药师共享患者药物治疗信息。
文献中 MR 的概念和药师在该过程中的主导活动以及药物治疗评估重点和与患者及其他护理提供者的沟通策略存在差异，表明需要对该过程和概念进行标准化。
