Effectiveness of Medication Reconciliation in a Chinese Hospital: A Pilot Randomized Controlled Trial

Abstract

Dongyan Chai,1,2,* Zhihui Liu,3,* Liuyi Wang,3 Hongyan Duan,2,3 Chenglong Zhao,1 Chengyang Xu,2 Dongyan Zhang,1 Qiongrui Zhao,4 Peizhi Ma1 1Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, Henan People’s Republic of China; 2International Medical Center of Henan Province, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China; 3Department of General Practice, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China; 4Department of Clinical Research Service Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Peizhi Ma, Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Weiwu Road 7, Zhengzhou, Henan, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: Implementing medication reconciliation (MR) was complex and challenging because of the variability in the guidance provided for conducting. The processes of MR adopted in China were different from that recommended by the World Health Organization. A pilot study to inform the design of a future randomized controlled trial to determine the effectiveness of these two workflows was undertaken.Methods: Patients taking at least one home/regular medication for hypertension, diabetes, or coronary heart disease were recruited at admission, and then were randomized using a computer-generated random number in a closed envelope. In the study group, the pharmacist reviewed electronic medical record systems before communication with patients. In the control group, pharmacists communicated with patients at patient’s admission. The time investment of pharmacists for MR process, the number of unintended medication discrepancies, and physician acceptance were tested as outcome measures.Results: One hundred and forty adult patients were randomized, of which 66 patients in the intervention received MR within 24 hours, while 58 patients in control received MR at some point during admission. The most common condition in the study group was hypertension (coronary heart disease in the control group). The workflow of the study group can save an average 7 minutes per patient compared with the WHO recommended process [17.5 minutes (IQR 14.00, 28.25) vs 24.5 minutes (IQR17.75, 35.25), p = 0.004]. The number of unintended discrepancies was 42 in the study group and 34 in the control group (p = 0.33). Physicians’ acceptance in the study and control groups were 87.5% and 92.3%, respectively (p = 0.87).Conclusion: The results suggest that changes in outcome measures were in the appropriate direction and that the time limit for implementing MR can be set within 48 hours. A future multi-centre RCT study to determine the effectiveness of MR is feasible and warranted.Keywords: medication reconciliation, workflow, prospective studies, pharmacist, randomized controlled trial

Keywords

• medication reconciliation
• workflow
• prospective studies
• pharmacist
• randomized controlled trial