Impacto da conciliação de medicamentos sobre desfechos clínicos, humanísticos e econômicos em pacientes não hospitalizados

Abstract

Introduction:Medication reconciliation (MC) corresponds to the formal process of obtaining complete list of medications in use by a patient, which can be applied during the transition of care. Through it, it becomes possible to avoid medication errors, through the identification and consequent resolution of potential problems and discrepancies in pharmacotherapy, thus promoting patient safety.. However, the impact of this intervention on health outcomes in outpatients is still poorly understood. Objective: To assess the influence of MC on clinical, economic and humanistic outcomes in adult outpatients. Method: A systematic review of studies was carried out that verified the association between the proposed intervention and some clinical, economic or humanistic outcomes published until July 2021, identified by searching the Cochrane Library, Embase, LILACS, Pubmed/Medline, Scopus, CINAHL and Web of Science databases. The search strategy involved words with the terms MESH: Medication Reconciliation, Ambulatory care, Ambulatory care facilities, Primary Health Care, Community Pharmacy Services and non-MESH: Mortality, Morbidity, Drug Costs, Quality of life and Quality-adjusted life Years. Results: A total of 6908 articles were identified, of which 28 studies were selected for full text reading. At the end of the selection process, 13 studies were included in this review, being 8 cohort studies and 5 quasiexperimental studies. Considering the cohort articles with the highest methodological quality, most of which observed an association between MC and outcome, evidence indicates a possible benefit of applying MC on readmission rates and visits to urgency/emergency units.The association of MC with reduced hospital readmission was also observed in quasiexperimental studies, which in turn also had an influence on length of hospital stay. A limited number of studies were found considering the economic outcome, however there is initial evidence that MC performed in non-hospitalized patients brings benefits such as cost reduction. None of the included articles considered humanistic outcomes.Conclusion:To date, the scientific literature indicates that MC can affect certain health outcomes in outpatients, such as hospital readmissions and visits to the urgency/emergency unit. Given the limited number of studies and the use of certain outcomes, especially those related to economic and humanistic components – there is a need to investigate the real impact of MC in additional studies.