Table 3.

Clinical pharmacist activities associated with 30-day hospital readmissions and representations (unless specified), categorised by clinic type.

Legend: D/C: discharge; med: medication; NS: Not stated; PCP: primary care physician; Clinic type: PDC: Post-discharge clinic; IPC+PDC: Inpatient clinical pharmacy service; CC: Collaborative post-discharge clinic. Method of follow-up: P: Phone; F: Clinic (face to face); V: Virtual. Outcome: H: 30-day hospital readmission; ED: 30-day representation; H + ED composite 30-day readmissions/representations only; Green = primary outcome, Orange = secondary outcome.

Intervention delivered: Usual care; Usual care (single intervention component only); Inpatient clinical pharmacy service; Post-discharge follow-up; Incorporated into MTM/CMM/CPP.

^aStatistically significant for ED/urgent care visit, not significant for 30-day readmission.

^bNot statistically significant for 30-day readmission rate (all-cause), statistically significant for 30-day readmission rate (heart disease or same disease state).

^cNot statistically significant for 30-day readmission rate (all-cause), statistically significant for 30-day readmission rate (sub-group analysis).

^dNot statistically significant for 30-day readmission rate (all-cause), statistically significant for 90-day readmission rate.

^eMTM: MTM services include the performing of a comprehensive pharmaceutical care review by ensuring all medication therapies, over the counter and herbal products are safe and effective, providing patient or carer education to optimise medication use, as well as liaising with a patients’ PCP or other health care providers to optimise medication therapy.^91,92

^fCMM: is an expansion on MTM and ensures that patients’ medications are appropriate, effective, safe and provides ongoing monitoring and review. CMM incorporates the development of a patient-centred care plan that assesses a patients’ clinical state and requires collaboration among members of the health care team and is continually updated as needed.⁹³

^gCPP: Clinical Pharmacist Practitioner is a licensed pharmacist advanced practice provider, who may prescribe medication therapy and order appropriate monitoring tests in accordance with an agreed protocol under the supervision of a physician.⁹⁴

^HIHigh Intensity.