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Faculty of Pharmacy, The University of Sydney, Sydney, Australia
Professor of Clinical Pharmacy and Pro-Dean, Faculty of Pharmacy, The University of Sydney; Conjoint Professor, Faculty of Medicine, University of New South Wales, Sydney
Senior Lecturer, Faculty of Pharmacy, The University of Sydney
Senior Lecturer, Faculty of Pharmacy, The University of Sydney
Reprints: Ms. Ellitt, Faculty of Pharmacy A15, The University of Sydney, Sydney, NSW 2006, Australia, fax 61 2 93514391, glenae{at}pharm.usyd.edu.au
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.
Key Words: cardiovascular disease, continuity of care, depression, diabetes, medications, pharmacist
Published Online, March 31, 2009. www.theannals.com, DOI 10.1345/aph.1L505
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  M. D (Mick) Murray Continuity of Health Care and the Pharmacist: Let's Keep It Simple Ann. Pharmacother., April 1, 2009; 43(4): 745 - 747. [Abstract] [Full Text] [PDF]
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