Quality Patient Care and Pharmacists' Role in Its Continuity

Abstract

Spanish

French

Background:

Continuity of care is important for the delivery of quality health care. Despite the abundance of research on this concept in the medical and nursing literature, there is a lack of consensus on its definition. As pharmacists have moved beyond their historical product-centered practice, a source of patient-centered research on continuity of care for practice application is required.

Objective:

To determine the scope of research in which pharmacists were directly involved in patients' continuity of care and to examine how the phrase continuity of care was defined and applied in practice.

Methods:

A working definition of continuity of care and a tool for relevance quality assessment of search articles were developed. MEDLINE, International Pharmaceutical Abstracts, EMBASE, and the Cochrane Collaboration evidence-based medicine reviews and bibliographies were searched (1996–March 2008). Reporting clarity was assessed by the Consolidated Standards of Reporting Trials checklist and outcomes were grouped by economic, clinical, and/or humanistic classification.

Results:

The search yielded 21 clinical and randomized controlled trials, including 11 pharmacist-only and 10 multidisciplinary studies. A broad range of research topics was identified and detailed analysis provided ready reference for considerations of research replication or practice application. Studies revealed a range of research aims, settings, subject characteristics, attrition rates and group sizes, interventions, measurement tools, outcomes, and definitions of continuity of care. Research focused on patients with depression (n = 4), cardiovascular disease {n = 4), diabetes (n = 2), and dyslipidemia (n = 1); specific drugs included non–tricyclic antidepressants, cardiovascular drugs, and benzodiazepines. From the proposed endpoints of economic cost (n = 6) and clinical (n = 14) and humanistic (n = 16) outcomes, 15 studies reported statistically significant results.

Conclusions:

Medication management at primary, secondary, and tertiary levels of care indicated an expanded role and collaboration of pharmacists in continuity of care. However, the exclusion of disadvantaged patients in 19 studies is at odds with continuity of care for these patients, who may have been the most in need for the same reason that they were excluded.

Keywords

cardiovascular disease continuity of care depression diabetes medications pharmacist

Get full access to this article

View all access options for this article.

References

Korcok

. US family physicians battling for their livelihood. Can Med Assoc J 1983;129:1223–6.

Stewart

. Continuity, care, and commitment: the course of patient–clinician relationships. Ann Fam Med 2004;2:388–90. DOI 10.1370/afm.236

DeMaeseneer

DePrins

Gosset

Heyerick

. Provider continuity in family medicine: does it make a difference for total health care costs? Ann Fam Med 2003;1:144–8.

Saultz

. Defining and measuring interpersonal continuity of care. Ann Fam Med 2003;1:134–43. DOI 10.1370/afm.23

Holland

Harris

. Discharge planning, transitional care, coordination of care, and continuity of care: clarifying concepts and terms from the hospital perspective. Home Health Care Services Quarterly (The Ha-worth Press Inc) 2007;26:3–19.

Haggerty

Burge

Levesque

J-F

. Operational definitions of attributes of primary health care: consensus among Canadian experts. Ann Fam Med 2007;5:336–44. DOI 10.1370/afm.682

Freeman

Horder

Howie

. Evolving general practice consultation in Britain: issues of length and context (primary care). Br Med J 2002;324:880–3. DOI 10.1136/bmj.324.7342.880

Hjortdahl

. Ideology and reality of continuity of care. Fam Med 1990;22:361–4.

Hibberd

. The primary/secondary interface. Cross-boundary teamwork—missing link for seamless care? J Clin Nurs 1998;7:274–82. DOI 10.1046/j.1365-2702.1998.00233.x

10.

Haggerty

Reid

Freeman

Starfield

Adair

McKendry

. Continuity of care: a multidisciplinary review. Br Med J 2003;327:1219–21. DOI 10.1136/bmj.327.7425.1219

11.

Helleso

Lorensen

. Inter-organizational continuity of care and the electronic patient record: a concept development. Int J Nurs Stud 2005;42:807–22. DOI 10.1136/bmj.327.7425.1219

12.

Vuong

Marriott

. Potential role of the community liaison pharmacist: stakeholder views. Int J Pharmacy Practice 2006;14:135–48. DOI 10.121l/ijpp.14.2.0008

13.

Kuehl

Chrischilles

Sorofman

. System for exchanging information among pharmacists in different practice environments. J Am Pharm Assoc 1998;38:317–24.

14.

Cochrane Collaboration Group. Effective practice and organisation of care review: Epoc. The data collection checklist. Series Editors L McAuley and C Ramsay. Ottawa: Institute of Population Health, 2002.

15.

National Health Service. Undertaking systematic reviews of research on effectiveness. CRD guidelines for those carrying out or commissioning reviews. CRD Report 4. York Y01 5DD: University of York, York Publishing Services Ltd., 1996.

16.

Altman

Schulz

Moher

. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001;134:663–94.

17.

Bravata

McDonald

Shojania

Sundarman

Owens

. Challenges in systematic reviews: synthesis of topics related to the delivery, organization, and financing of health care. Ann Intern Med 2005;142:1056–65.

18.

Thomas

Ciliska

Dobbins

Micucci

. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs 2004;1:176–84. DOI 10.11111/j.1524-475X.2004.04006.x

19.

Kozma

Reeder

Schulz

. Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther 1993;15:1121–32; discussion 20.

20.

Gunter

. The role of the ECHO model in outcomes research and clinical practice improvements. Am J Manag Care (Supplement) 1999;5: S217–24.

21.

Turpin

. CONSORT and QUOROM guidelines for reporting randomized clinical trials and systematic reviews. Am J Orthod Dentofacial Or-thop 2005;128:681–6. DOI 10.1016/j.ajodo.2005.10.010

22.

Glasziou

Irwig

Bain

Colditz

. Systematic reviews in health care: a practical guide. United Kingdom: Cambridge University Press, 2001.

23.

Bero

Grilli

Grimshaw

Harvey

Oxman

Thomson

. Getting research findings into practice: closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. Br Med J 1998;317:465–8.

24.

Needleman

. A guide to systematic reviews. J Clin Periodontal 2002;29:6–9. DOI 10.1034/j.1600-051X.29.s3.15.x

25.

Gray

Evans

Sweeney

. Towards a theory of continuity of care. J R Soc Med 2003;96:160–6. DOI 10.1258/jrsm.96.4.160

26.

Bell

McLachlan

Asiani

Whitehead

Chen

. Community pharmacy services to optimise the use of medications for mental illness: a systematic review. Australia and New Zealand Health Policy 2005;2:29–40. DOI 10.1186/1743-8462-2-29

27.

Boudreau

Capoccia

Sullivan

. Collaborative care model to improve outcomes in major depression. Ann Pharmacother 2002;36:585–91. DOI 10.1345/aph.1A259

28.

Horowitz

Goldberg

Martin

. Conducting a randomized controlled trial of CQI and academic detailing to implement clinical guidelines. Jt Comm J Qual Improv 1996;22:734–50.

29.

Reeder

Dickson

Kozma

Santell

. ASHP national survey of pharmacy practice in acute care settings, 1996. Am J Health Syst Pharm 1997;54:653–69.

30.

Renders

Valk

Griffin

Wagner

Eijk

Assendelft

. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Reviewers Handbook 2001; CD001481. DOI 10.1002/14651858.CD001481

31.

Santell

. ASHP national survey of hospital-based pharmaceutical services—1994. Am J Health Syst Pharm 1995;52:1179–98.

32.

Schumock

Butler

Meek

Vermeulen

Arondekar

Bauman

. Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Task force on economic evaluation of clinical pharmacy services of the American College of Clinical Pharmacy. Pharmacother 2003;23:113–32. DOI 10.1592/phco.23.1.113.31910

33.

Vanscoy

. Outpatient management of venous thromboembolism. J Thromb Thrombolysis 1999;7:109–12. DOI 10.1023/A: 1008821217432

34.

Walker

Willey

. Impact on drug costs and utilization of a clinical pharmacist in a multisite primary care medical group. J Manag Care Pharm 2004;10:345–54.

35.

Whelan

. Development of a Canadian family medicine pharmacy practice experience programme. J Clin Pharm Ther 2002;27:335–41. DOI 10.1046/j.1365-2710.2002.00413.x

36.

Worley-Louis

Schommer

Finnegan

. Construct identification and measure development for investigating pharmacist-patient relationships. Patient Educ Couns 2003;51:229–38. DOI 10.1016/S0738-3991(02)00222-7

37.

Zillich

Doucette

Carter

Kreiter

. Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective. Value Health 2005;8:59–66. DOI 10.1111/j.1524-4733.2005.03093.x

38.

Bolas

Brookes

Scott

McElnay

. Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharm World Sci 2004;26:114–20. DOI 10.1023/B:PHAR.0000018601.11248.89

39.

Borenstein

Graber

Saltiel

. Physician-pharmacist co-management of hypertension: a randomized, comparative trial. Pharmacotherapy 2003;23:209–16.

40.

Brook

van Hout

Nieuwenhuyse

Heerdink

. Impact of coaching by community pharmacists on drug attitude of depressive primary care patients and acceptability to patients; a randomized controlled trial. Eur Neuropsychopharmacol 2003;13:1–9. DOI 10.1016/S0924-977X(02)00074-3

41.

Bucci

Jackevicius

McFarlane

Liu

. Pharmacist's contribution in a heart function clinic: patient perception and medication appropriateness. Can J Cardiol 2003;19:391–6.

42.

Bungay

Adler

Rogers

. Description of a clinical pharmacist intervention administered to primary care patients with depression. Gen Hosp Psychiatry 2004;26:210–8. DOI 10.1016/j.genhosppsych.2004.01.004

43.

Capoccia

Boudreau

Blough

. Randomized trial of pharmacist interventions to improve depression care and outcomes in primary care. Am J Health Syst Pharm 2004;61:364–72.

44.

Crotty

Rowett

Spurling

Giles

Phillips

. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother 2004;2:257–64. DOI 10.1016/j.amjopharm2005.01.001

45.

Dudas

Bookwalter

Kerr

Pantilat

. The impact of follow-up telephone calls to patients after hospitalization. Am J Med 2001;111: 26S–30S. DOI 10.1016/S0011-5029(02)90031-3

46.

Finley

Rens

Pont

. Impact of a collaborative care model on depression in a primary care setting: a randomized controlled trial. Pharmacother 2003;23:1175–85. DOI 10.1592/phco.23.10.1175.32760

47.

Jaber

Halapy

Fernet

Tummalapalli

Diwakaran

. Evaluation of a pharmaceutical care model on diabetes management. Ann Pharmacother 1996;30:238–43.

48.

Murray

Young

Morrow

. Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure. Am J Geriatr Pharmacother 2004;2:53–65. DOI 10.1016/S1543-5946(04)90007-4

49.

Nickerson

MacKinnon

Roberts

Saulnier

. Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service. Healthcare Quarterly 2005;8 Spec No:65–72.

50.

Paulos

Nygren

CEA

Celedon

Carcamo

. Impact of a pharmaceutical care program in a community pharmacy on patients with dyslipidemia. Ann Pharmacother 2005;39:939–43. DOI 10.1345/aph.1E347

51.

Rothman

Malone

Bryant

. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Am J Med 2005;118:276–84. DOI 10.1016/j.amjmed.2004.09.017

52.

Smith

McGowan

Moss-Barclay

Wheater

Knass

Chrystyn

. An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital. Br J Clin Pharmacol 1997;44:163–5. DOI 10.1046/j.1365-2125.1997.00629.x

53.

Voirol

Kayser

Chang

Youmans

. Impact of pharmacists' interventions on the pediatric discharge medication process. Ann Pharmacother 2004;38:1597–602. DOI 10.1345/aph.1E087

54.

Sellors

Kaczorowski

Sellors

. A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. Can Med Assoc J 2003;169:17–22.

55.

Sorensen

Stokes

Purdie

Woodward

Elliott

Roberts

. Medication reviews in the community: results of a randomized, controlled effectiveness trial [erratum appears in Br J Clin Pharmacol 2005 Mar;59(3):376]. Br J Clin Pharmacol 2004;58:648–64. DOI 10.1111/j.1365-2125.2004.02220.x

56.

Fischer

Defor

Cooper

. Pharmaceutical care and health care utilization in an HMO. Eff Clin Pract 2002;5:49–57.

57.

Al-Rashed

Wright

Roebuck

Sunter

Chrystyn

. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol 2002;54:657–64. DOI 10.1046/j.1365-2125.2002.01707.x

58.

Eakin

Mykhalovski

. Reframing the evaluation of qualitative health research: reflections on a review of appraisal guidelines in the health sciences. J Eval Clin Pract 2003;9:187–94. DOI 10.1046/j.1365-2753.2003.00392.x

Quality Patient Care and Pharmacists' Role in Its Continuity—A Systematic Review