Barriers and facilitators of medication reconciliation through the Consolidated Framework for Implementation Research (CFIR): a systematic review

Fathul Muin; Akbar Eka Nugraha

doi:10.35814/jifi.v24i1.2026

Penulis

Fathul Muin Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
Akbar Eka Nugraha Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Sebelas Maret, Surakarta, 57126, Indonesia

DOI:

https://doi.org/10.35814/jifi.v24i1.2026

Kata Kunci:

Consolidated Framework for Implementation Research (CFIR), medication reconciliation, patient safety, pharmacist-led interventions, transitions of care

Abstrak

Medication reconciliation (MedRec) is an intervention that ensures patient safety during healthcare transitions. The Consolidated Framework for Implementation Research (CFIR) was applied to deduce the contextual factors that impact the adoption of MedRec. This systematic review aimed to synthesize evidence on MedRec or pharmacist-led transition-of-care interventions that applied CFIR. A systematic review was conducted according to the PRISMA guidelines. Searches were performed in PubMed, Scopus, and ScienceDirect for studies published between 2000 and 2025 that employed Boolean operators (AND/OR) with keywords (“medication reconciliation” OR “pharmacist-led transition” OR “Pharmacist Discharge Care”) AND (“Consolidated Framework for Implementation Research” OR “CFIR” OR “Implementation Research”). Eligible studies were peer-reviewed, mixed-methods, or implementation research that applied the CFIR to evaluate MedRec. A total of 690 studies were identified and screened by title and abstract, followed by a full-text assessment. Six studies were considered for inclusion after full-text screening. Data were extracted and synthesized narratively, and the findings were mapped across the five CFIR domains. Key facilitators were primarily related to Intervention Characteristics, including adaptability and perceived value, and Inner Setting, including leadership engagement and a supportive organizational culture. The characteristics of individuals included clinical expertise and commitment to medication safety, while effective interprofessional communication supported the implementation across settings. Common barriers were identified within the Inner Setting and Process domains, including limited resources, unclear professional roles, insufficient training, and poor integration of MedRec into existing work flows. The Outer Setting was less frequently reported but reflected patient needs and broader system-level influences. Overall, the CFIR provides a comprehensive framework for understanding the determinants affecting the implementation of MedRec.

Referensi

[1] E. Almanasreh, R. Moles, and T. F. Chen, ‘The medication reconciliation process and classification of discrepancies: a systematic review’, British journal of clinical pharmacology, vol. 82, no. 3, pp. 645–658, 2016, Accessed: Dec. 22, 2025. [Online]. Available: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.13017

[2] T. A. Moges, T. Y. Akalu, and F. D. Sema, ‘Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation’, BMC Health Serv Res, vol. 22, p. 1251, Oct. 2022, doi: 10.1186/s12913-022-08628-5.

[3] C. Picton and H. Wright, Keeping patients safe when they transfer between care providers: getting the medicines right. Royal Pharmaceutical Society of Great Britain (RPSGB), 2011.

[4] F. F. M. Al-Qahtani et al., ‘Enhancing medication safety and care transitions: A systematic review of roles and strategies in healthcare settings’, Journal of Primeasia, vol. 3, no. 1, pp. 1–10, 2022.

[5] C. Weber, C. Meyer-Massetti, and N. Schönenberger, ‘Pharmacist-led interventions at hospital discharge: a scoping review of studies demonstrating reduced readmission rates’, International Journal of Clinical Pharmacy, vol. 47, no. 1, pp. 15–30, 2025.

[6] A. B. Mekonnen, A. J. McLachlan, and J. E. Brien, ‘Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis’, BMJ Open, vol. 6, no. 2, p. e010003, Feb. 2016, doi: 10.1136/bmjopen-2015-010003.

[7] L. J. Anderson et al., ‘Effect of medication reconciliation interventions on outcomes: A systematic overview of systematic reviews’, American Journal of Health-System Pharmacy, vol. 76, no. 24, pp. 2028–2040, Dec. 2019, doi: 10.1093/ajhp/zxz236.

[8] K.-L. Chen, M.-F. Wen, H.-Y. Tsai, J.-H. Chen, and Y.-M. Huang, ‘Challenges in implementing pharmacist-led admission medication reconciliation in hospital practice: a qualitative study’, BMC Health Serv Res, vol. 26, p. 81, Dec. 2025, doi: 10.1186/s12913-025-13869-1.

[9] D. S. Alghamdi et al., ‘Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: a multicentre study’, BMJ Open Qual, vol. 12, no. 2, p. e002121, Jun. 2023, doi: 10.1136/bmjoq-2022-002121.

[10] A. Reupert, ‘Making things happen: the need for implementation research’, Advances in Mental Health, vol. 19, no. 1, pp. 1–3, Jan. 2021, doi: 10.1080/18387357.2021.1894529.

[11] C. M. Reardon et al., ‘The Consolidated Framework for Implementation Research (CFIR) User Guide: a five-step guide for conducting implementation research using the framework’, Implement Sci, vol. 20, p. 39, Aug. 2025, doi: 10.1186/s13012-025-01450-7.

[12] L. J. Damschroder, D. C. Aron, R. E. Keith, S. R. Kirsh, J. A. Alexander, and J. C. Lowery, ‘Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science’, Implementation science, vol. 4, no. 1, p. 50, 2009.

[13] L. J. Damschroder, C. M. Reardon, M. A. Opra Widerquist, and J. Lowery, ‘Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum’, Implementation science, vol. 17, no. 1, p. 7, 2022.

[14] H. Lam et al., ‘Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening’, Implement Sci Commun, vol. 2, p. 57, May 2021, doi: 10.1186/s43058-021-00150-9.

[15] B. D. Fernandes, A. A. Foppa, L. R. Ayres, and C. Chemello, ‘Implementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research’, Research in Social and Administrative Pharmacy, vol. 18, no. 9, pp. 3631–3637, Sep. 2022, doi: 10.1016/j.sapharm.2022.01.010.

[16] L. T. Murry, M. S. Keller, J. M. Pevnick, J. L. Schnipper, and K. A. Kennelty, ‘A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework’, BMC Health Serv Res, vol. 22, p. 186, Feb. 2022, doi: 10.1186/s12913-022-07583-5.

[17] O. Oche et al., ‘Pharmacist, Nurse, and Physician Perspectives on the Implementation of the Pharmacist Discharge Care (PHARM-DC) Intervention: A Qualitative Study’, Res Social Adm Pharm, vol. 20, no. 8, pp. 740–746, Aug. 2024, doi: 10.1016/j.sapharm.2024.04.009.

[18] M. J. Page et al., ‘The PRISMA 2020 statement: an updated guideline for reporting systematic reviews’, BMJ, p. n71, Mar. 2021, doi: 10.1136/bmj.n71.

[19] S. H. Sanchez, S. S. Sethi, S. L. Santos, and K. Boockvar, ‘Implementing medication reconciliation from the planner’s perspective: a qualitative study’, BMC Health Serv Res, vol. 14, p. 290, Jul. 2014, doi: 10.1186/1472-6963-14-290.

[20] S. Alshihab, M. I. M. Ibrahim, M. Al-Zaidan, and M. A. Hadi, ‘A consolidated framework for implementation research (CFIR) guided exploration of key informant perspectives on establishing a pharmacist-led anticoagulation service in primary care: a qualitative study’, Int J Clin Pharm, vol. 47, no. 2, pp. 335–344, 2025, doi: 10.1007/s11096-024-01830-x.

[21] N. Alaa Eddine, J. Schreiber, A. F. El-Yazbi, H. Shmaytilli, and M. E. K. Amin, ‘A pharmacist-led medication review service with a deprescribing focus guided by implementation science’, Front Pharmacol, vol. 14, p. 1097238, Jan. 2023, doi: 10.3389/fphar.2023.1097238.