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      Conciliación de medicamentos dirigida por farmacéuticos en los servicios de urgencias hospitalarias de Brasil: revisión sistemática exploratoria Translated title: Pharmacist-led medication reconciliation in emergency hospital services in Brazil: a scoping review

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          Abstract

          Resumen Objetivo: Documentar la evidencia de la conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil. Método: Se realizó una revisión sistemática exploratoria de bases de datos electrónicas LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science, Clinical Trials, REBEC y Cochrane para identificar estudios publicados hasta el 20 de octubre de 2021. Los estudios incluidos abordaban la conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil, independientemente de las condiciones clínicas y los resultados evaluados. Resultados: Se recuperaron un total de 168 estudios, tres de los cuales cumplieron los criterios de inclusión. La mayoría de los estudios realizaban la conciliación de la medicación dirigida por el farmacéutico en las admisiones al servicio de urgencias, pero ésta no era la principal atribución farmacéutica en ese contexto. Los errores de medicación fueron identificados durante el proceso de conciliación de medicamentos, siendo la omisión de medicamentos el error más reportado. Los estudios no hacían referencia a la importancia de recabar un historial farmacológico lo más completo posible ni a los resultados humanísticos, económicos y clínicos de la conciliación de medicamentos dirigida por farmacéuticos. Conclusiones: Esta revisión sistemática exploratoria reveló la falta de evidencia sobre el proceso de conciliación de medicamentos dirigido por farmacéuticos en los servicios de urgencias de Brasil. Los hallazgos sugieren la necesidad de seguir investigando sobre este asunto.

          Translated abstract

          Abstract Objective: This scoping review aimed to map the evidence of pharmacist-led medication reconciliation in hospital emergency services in Brazil. Method: We performed a scoping review by searching electronic databases LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science, Clinical trials, REBEC e Cochrane and conducting a manual search to identify studies published up to 20 October 2021. Studies that addressed pharmacist-led medication reconciliation in hospital emergency services in Brazil, regardless of clinical conditions, and outcomes evaluated, were included. Results: A total of 168 studies were retrieved, with three matching the inclusion criteria. Most studies performed pharmacist-led medication reconciliation at emergency department admissions, but it was not the primary pharmaceutical attribution in this setting. Medication errors were identified during the medication reconciliation process, being drug omission the most reported. Studies did not describe the concerns in collecting the best medication history from patients and the humanistic, economic, and clinical outcomes of pharmacist-led medication reconciliation. Conclusions: This scoping review revealed the lack of evidence about the pharmacist-led medication reconciliation process in the emergency setting in Brazil. The findings suggest the need for future studies in this context.

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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              Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis

              Objectives Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients’ clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. Design Systematic review and meta-analysis. Methods We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity. Results 17 studies involving 21 342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results. Conclusion Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety.
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                Author and article information

                Journal
                fh
                Farmacia Hospitalaria
                Farm Hosp.
                Grupo Aula Médica (Toledo, Toledo, Spain )
                1130-6343
                2171-8695
                August 2022
                : 46
                : 4
                : 234-243
                Affiliations
                [2] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Ciências Farmacêuticas de Ribeirão Preto orgdiv2Centro de Pesquisa em Assistência Farmacêutica e Farmácia Clínica Brazil
                [1] Ribeirão Preto São Paulo orgnameUniversidade de São Paulo orgdiv1Unidade de Emergência Brazil
                Article
                S1130-63432022000400005 S1130-6343(22)04600400005
                10.7399/fh.11838
                a8de652b-8c7d-4c6e-aff0-75e94c2335eb

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 09 March 2022
                : 16 September 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 10
                Product

                SciELO Spain

                Categories
                Revisiones

                Emergency service,Medication reconciliation,Farmacéuticos,Relaciones profesional-paciente,Hospital,Servicio de urgencias,Conciliación de medicamentos,Pharmacists,Professional-patient relations

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