The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary-secondary care interface.Setting
The study involved patients discharged from two acute-care tertiary teaching hospitals in Melbourne, Australia, returning to independent living.Methods
Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8-12 weeks after discharge to assess the impact of the intervention on adherence and medication knowledge.Key findings
The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1-14days). Consultations lasted 15-105 min (mean, 49 min; SD, ±21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow-up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ±3.27) for standard-care patients (P = 0.662). At follow-up self-perceived medication understanding was found to have improved in intervention patients (P<0.001) and significant improvements from baseline in medication adherence were found in both standard-care (P<0.022) and intervention (P<0.005) groups; however, adherence had improved more in intervention patients.Conclusion
The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home.