What Impact Does Pharmacist Led Medication Reconciliation Strategies Have on Reduction of Medication Errors in the Older Adult?

To study the role of the pharmacist in optimizing medication reconciliation strategies  and the potential impact on medication related problems in community dwelling older adults Purpose

 Purpose

To determine what effect a pharmacist-led intervention can have on medication reconciliation strategies /medication errors in the community dwelling older adult.

Methods

This review considered studies that evaluated the effects of medication reconciliation strategies on medication errors in community dwelling older adults. The target population was older adults, 65 years and older and living in the community. Excluded were any older adults with dementia or who were dependent on family members or other individuals for the provision of care.

The primary outcome measure studied in this review was number of medication errors.

Results

This review yielded three studies for consideration; 2 level one randomized controlled trials (RCT’s), and 1 level three prospective randomized comparative study.  Each study presented evidence to support the positive outcomes of a pharmacist led medication reconciliation process on medication errors for community dwelling older adults. The way in which the pharmacist conducted the medication reconciliation process, however, varied greatly in each of these studies. Reconciliation processes included: medication reconciliation and review face-to-face with patients in the physician’s office; home visits with patients; and a reconciliation process that stemmed from a team based approach to care.

Implications for practice

This review suggests that clinicians support pharmacist-led medication reconciliation, specifically for older adults residing in community settings. This support is integral to the health of the older adults in terms of identifying and preventing medication errors, and in the development of appropriate recommendations to primary care providers for appropriate medication adjustments.

Implications for Research

This review underscores the need for continued research in order to determine the effectiveness of pharmacist led medication reconciliation strategies on medication errors in the community dwelling older adults. Additionally, there is a need to develop more research initiatives that study medication reconciliation within a team-based approach; a need for more evidence-based information relating to interdisciplinary team functioning. Research should focus on who the members of the team are, roles and responsibilities of each team member, what facilitates the effectiveness of a team, and most importantly, the impact on medication errors. Additionally the context within which medication reconciliation is carried out, such as types of settings - in the patient’s home, in the pharmacy, in the primary care provider’s office - warrants future research.