Pharmacy World & Science

, 30:810 | Cite as

Post-discharge medication reviews for patients with heart failure: a pilot study

  • Anne Ponniah
  • Sepehr Shakib
  • Christopher J. Doecke
  • Merelyn Boyce
  • Manya AngleyEmail author
Research Article


Background Medication misadventure is greatest at times of change such as the transition from hospital to community. Patients with heart failure are prone to medication misadventure due to polypharmacy, inappropriate medication use and frequent readmissions. Objective To identify the barriers encountered when implementing a Liaison Pharmacist facilitated post-discharge medication management service for patients with heart failure. Method A Liaison Pharmacist contacted the patient’s General Practitioner (GP), sent them a medication discharge summary and organised an appointment for the patient with the GP approximately 2 days post-discharge to make a Home Medicines Review (HMR) referral. The patient’s community pharmacist was also contacted, sent a medication discharge summary and requested to engage an accredited pharmacist to undertake the HMR. The Liaison Pharmacist arranged for the HMR report to be sent to the outpatient department clinic to enable assessment of outcomes at the outpatient department follow-up 12 weeks post-discharge. Main outcome measure: GP HMR referral rates. Results 90 patients were offered the service. Fifty-nine patients (66%) agreed to have their GP contacted with 56 GPs agreeing to order a HMR and 41 patients having an HMR post-discharge. Barriers to the implementation of a HMR post-discharge included: patient withdrawal, low GP awareness of the HMR process and conducting the HMR in a timely manner. Conclusion This study provides evidence for the feasibility of a post-discharge pharmacy service for patients with heart failure although barriers to implementation have been identified.


Australia Care transition Continuity of care Heart failure Liaison pharmacist Medication management Medication review Seamless care 



The assistance provided throughout the project by Ms. Olimpia Nigro, Senior Clinical Pharmacist, Royal Adelaide Hospital, is acknowledged with gratitude.


This study was supported by the Sansom Institute, University of South Australia and the Royal Adelaide Hospital.

Conflict of interest

None declared


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Anne Ponniah
    • 1
  • Sepehr Shakib
    • 2
  • Christopher J. Doecke
    • 3
  • Merelyn Boyce
    • 4
  • Manya Angley
    • 5
    Email author
  1. 1.University of South AustraliaAdelaideAustralia
  2. 2.Royal Adelaide HospitalAdelaideAustralia
  3. 3.Royal Adelaide Hospital, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
  4. 4.SA Divisions of General Practice IncorporatedWayvilleAustralia
  5. 5.Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia

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