Effectiveness of post-hospital discharge pharmacist care on clinical
outcomes.
Abstract
BACKGROUND: Clinic pharmacists have been shown to identify and resolve
medication related problems post-discharge, however, the impact on
patient clinical outcomes is unclear. AIMS: To identify hospital-based
post-discharge pharmacist clinics that provide medication review; report
the patient clinical outcomes measured; and describe the activities of
the clinical pharmacist. METHODS: Published studies evaluating a patient
clinical outcome following a post-discharge hospital clinic pharmacy
service were included. All studies needed a comparative design
(intervention vs usual care). Pubmed, Embase, CINAHL, PsycnINFO, Web of
Science, IPA and APAIS-Health databases were searched to identify
studies. The type of clinic and the clinical pharmacist activities were
linked to patient clinical outcomes. RESULTS: Fifty-seven studies were
included in the final analysis, 14 randomised controlled trials and 43
non-randomised studies. Three key clinic types were identified:
post-discharge pharmacist review alone, inpatient care plus
post-discharge review and post-discharge collaborative clinics. The
three main outcome metrics identified were hospital readmission and/or
representation, adverse drug events, and improved disease state metrics.
There was often a mix of these outcomes reported as primary and
secondary outcomes. High heterogeneity of interventions and clinical
pharmacist activities reported meant it was difficult to link clinical
pharmacist activities with the outcomes reported. CONCLUSIONS: A
post-discharge clinic pharmacist may improve patient clinical outcomes
such as hospital readmission and representation rates. Future research
needs to provide a clearer description of the clinical pharmacist
activities provided in both arms of comparative studies.