Pharmacist-led transition of care services in patients with cardiovascular disease: a systematic scoping review.

INTRODUCTION

Transition of care (ToC) is a critical time that requires effective management, especially for patients with cardiovascular disease, who have complex health needs. Pharmacists can play an integral role in improving medication safety and care coordination at ToC. This review determined the types of pharmacist-led multidisciplinary ToC services and associated outcomes in patients with cardiovascular disease.

METHODS

A systematic literature search of four databases; PubMed, Embase, CINAHL, and Scopus, was undertaken from inception until June 2023. Abstracts and full text were screened against eligibility criteria. Extracted data included study characteristics, ToC service descriptions, primary and secondary outcomes, limitations, and key findings. Study findings were synthesised narratively. The types of in-patient and post-discharge activities and their effect on patient outcomes were critiqued and presented.

RESULTS

Of the 1822 studies identified, 37 were included in the final review. The most common primary outcome reported was 30-day all cause readmissions (n=14). Pharmacist-led ToC services incorporated a diverse combination of inpatient and post-discharge activities. The most common in-patient activities included medication history and reconciliation, patient medication education, and medication review and optimisation. The most common post-discharge activities were medication review and optimisation, adherence assessments, and medication education. Multifaceted ToC services that involved inpatient and post-discharge activities demonstrated statistically significant changes in readmission rates and other patient reported outcomes.

CONCLUSION

A variety of multifaced approaches to pharmacist-led ToC services have been evaluated within many studies, reporting favourable effects on outcomes for patients with cardiovascular disease. Tailoring ToC services to specific patient populations and settings, targeting activities to high-risk patients, and a multidisciplinary approach, are important to optimise ToC and patient outcomes.