Medication Review and Medication Reconciliation

  • Nina Griese-MammenEmail author
  • Martin Schulz
  • Fabienne Böni
  • Kurt E. Hersberger


Medication review and medication reconciliation are systematic processes with the aim of increasing patient safety as well as effectiveness and efficiency on different levels. Whereas medication reconciliation is defined as the formal process of obtaining a complete and accurate list of each patient’s current medications with the main aim of detecting and solving discrepancies, medication review is a structured evaluation of a patient’s medications with the aim of detecting and solving drug-related problems (DRPs). The available information determines which DRPs can be detected. If a medication list/plan has to be critically appraised, then the list should first be complete and correct. This makes reconciliation automatically a prerequisite for a medication review.


Pharmaceutical Care Medication review Medication reconsiliation Drug-related problems Classification 


  1. 1.
    Zermansky AG. Who controls repeats? Br J Gen Pract. 1996;46:643–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  3. 3.
    Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74:573–80. Scholar
  4. 4.
    Bulajeva A, Labberton L, Leikola S, et al. Medication review practices in European countries. Res Social Adm Pharm. 2014;10:731–40. Scholar
  5. 5.
    Beers MH. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825. Scholar
  6. 6.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people. Version 2. Age Ageing. 2015;44:213–8. Scholar
  7. 7.
    Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51.CrossRefGoogle Scholar
  8. 8.
    Hanlon JT, Schmader KE. The medication appropriateness index at 20. Where it started, where it has been, and where it may be going. Drugs Aging. 2013; 30:893–900. Scholar
  9. 9.
    Tully MP, Seston EM. Impact of pharmacists providing a prescription review and monitoring service in ambulatory care or community practice. Ann Pharmacother. 2000;34:1320–31. Scholar
  10. 10.
    Jokanovic N, Tan EC, Sudhakaran S, et al. Pharmacist-led medication review in community settings. An overview of systematic reviews. Res Social Adm Pharm. 2017;13:661–85. Scholar
  11. 11.
    Geurts, Marlies M E, Talsma J, Brouwers, Jacobus R B J, de Gier, Johan J. Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient: a systematic review. Br J Clin Pharmacol. 2012;74:16–33. Scholar
  12. 12.
    NCBI. Medical Subheadings: Medication Reconciliation (2011). Accessed 04 Dec 2017.
  13. 13.
    NICE. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (2015). Accessed 04 Dec 2017.
  14. 14.
    ISMP Canada. Medication Reconciliation in acute care—getting started kit: safer healthcare now! Accessed 04 Dec 2017.
  15. 15.
    Coleman EA, Smith JD, Raha D, Min S-J. Posthospital medication discrepancies. Prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7. Scholar
  16. 16.
    Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital. A systematic review. CMAJ: Can Med Association J = journal de l’Association medicale canadienne. 2005;173:510–15. Scholar
  17. 17.
    Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies.Google Scholar
  18. 18.
    Eichenberger PM, Lampert ML, Vogel Kahmann I, Foppe van Mil JW, Hersberger KE. Classification of drug-related problems with new prescriptions using a modified PCNE classification system. Pharm World Sci. 2010;32:362–72.CrossRefGoogle Scholar
  19. 19.
    Mekonnen AB, McLachlan AJ, Brien J-AE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. A systematic review and meta-analysis. BMJ open. 2016;6:e010003. Scholar
  20. 20.
    Polinski JM, Moore JM, Kyrychenko P, et al. An insurer’s care transition program emphasizes medication reconciliation. Reduces Readmissions And Costs. Health Aff. 2016;35:1222–9. Scholar
  21. 21.
    Mergenhagen KA, Blum SS, Kugler A, et al. Pharmacist-versus physician-initiated admission medication reconciliation. Impact on adverse drug events. Am J geriatr Pharmacother. 2012;10:242–50. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Nina Griese-Mammen
    • 1
    Email author
  • Martin Schulz
    • 1
  • Fabienne Böni
    • 2
  • Kurt E. Hersberger
    • 2
  1. 1.ABDABerlinGermany
  2. 2.University of BaselBaselSwitzerland

Personalised recommendations