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Predictors for unintentional medication reconciliation discrepancies in preadmission medication: a systematic review

European Journal of Clinical Pharmacology volume 73, pages 1355–1377 (2017)Cite this article

Abstract

Purpose

Discrepancies in preadmission medication (PAM) are common and potentially harmful. Medication reconciliation is able to reduce the discrepancy rate, yet implementation is challenging. In order for reconciliation efforts to be more cost-effective, patients at high risk for reconciliation errors should be identified. The purpose of this systematic review is to identify predictors for unintentional discrepancies in PAM.

Methods

Medline and Embase were searched systematically until June 2017. Only studies concerning adult subjects were retained. Quantitative studies were included if predictors for unintentional discrepancies in the PAM had been determined on hospital admission. Variables were divided into patient-, medication-, and setting-related predictors based on a thematic analysis. Studies on identification of predictors for discrepancies and potentially harmful discrepancies were handled separately.

Results

Thirty-five studies were eligible, of which 5 studies focused on potentially harmful discrepancies. The following 16 significant variables were identified using multivariable prediction models: number of preadmission drugs, patient’s age, availability of a drug list, patients’ understanding of medication, usage of different outpatient pharmacies, number of high-risk drugs, discipline for which the patient is admitted, admitting physician’s experience, number and type of consulted sources, patient’s gender, type of care before admission, number of outpatient visits during the past year, class of medication, number of reimbursements, use of an electronic prescription system, and type of admission (elective vs emergency). The number of preadmission drugs was identified as a predictor in 20 studies. Potentially harmful discrepancies were ascertained in 5 studies with age found to have a predictive value in all 5 studies.

Conclusion

Multiple suitable predictors for PAM-related discrepancies were identified of which higher age and polypharmacy were reported most frequently.

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Acknowledgements

We want to thank Marleen Michels, for peer-reviewing our search query.

Contributors

Julie Hias, Lorenz Van der Linden, and Sabrina De Winter participated in the study concept, retrieval of articles, data analysis, interpretation of data, and preparation of the manuscript. Isabel Spriet participated in the study concept, interpretation of data, and preparation of the manuscript. Jos Tournoy, Peter Vanbrabant, and Ludo Willems participated in the interpretation of data and preparation of the manuscript.

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Affiliations

  1. Pharmacy Department, University Hospitals Leuven, Leuven, Belgium

    Julie Hias, Lorenz Van der Linden, Isabel Spriet, Ludo Willems & Sabrina De Winter

  2. Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium

    Lorenz Van der Linden, Isabel Spriet, Ludo Willems & Sabrina De Winter

  3. Department of General Internal Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium

    Peter Vanbrabant

  4. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium

    Jos Tournoy

  5. Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium

    Jos Tournoy

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  1. Julie Hias
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Julie Hias and Lorenz Van der Linden shared first author.

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Hias, J., Van der Linden, L., Spriet, I. et al. Predictors for unintentional medication reconciliation discrepancies in preadmission medication: a systematic review. Eur J Clin Pharmacol 73, 1355–1377 (2017). https://doi.org/10.1007/s00228-017-2308-1

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Keywords

  • Medication reconciliation
  • Reconciliation discrepancies
  • Hospitalization
  • Risk stratification
  • High-risk patients
  • Predictors