A systematic review of the role of community pharmacies in improving the transition from secondary to primary care

Aim
We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings.

Method
We systematically reviewed the literature on interventions that involved community pharmacy post discharge. We considered all relevant studies, including both randomised and non-randomised controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes.

Results
We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies; this limited the accuracy with which true impact could be considered.

Conclusions
There is evidence that interventions including a community pharmacist can improve drug related problems after discharge, however, impact on other outcomes is not consistent. Further studies are required which include process evaluations to fully describe the context of the intervention so as to better determine any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.