Efficacy of a transition of care service to reduce hospital readmissions for high-risk cardiology patients.

Pharmacist-led interdisciplinary transition of care service that will incorporate the following: The provision of written materials to patients, such as an updated discharge medication list, along with consumer medication information leaflets on newly prescribed medications. A senior pharmacist will lead the service and provide in-patient activities to the patient on discharge that will include medication review and reconciliation, discharge planning and organisation, supply of medications, medication counselling, and communication of any medication changes to primary care providers (i.e., community pharmacist or general practitioner). The pharmacist will also provide an out-patient follow-up consultation, which will also involve medication review and medication counselling after the patient has been discharged. The pharmacist will be supported by a nurse and indigenous healthcare worker who may also provide support in medication review and progress assessments. The pharmacist will be a senior clinician (Queensland Health practitioner level HP4) with a minimum of 3-4 years experience, the nurse will also be a senior practitioner (Grade 6) with a minimum of 3 years experience, and the indigenous healthcare worker will be an identified position to provide culturally safe care where it is needed. The mode of delivery will be face to face whilst the patient is in hospital. After they are discharged, the mode of delivery will mainly be through telephone or video for follow-up consultations. The option for a home visit to provide a face to face follow-up consultation will be provided on the basis of feasibiltiy and patient preference. The pharmacist will provide the service/intervention at least once during the patient's inpatient stay, and prior to discharge (e.g., 1 x 1 hour face to face consultation), and the follow-up consultation will be provided at least once (e.g., 30 mins to 1 hour for a telephone or video consultation, and up to 2 hours for a home visit) within 1 to 2 weeks post-discharge. The nurse and indigenous health worker will provide support in the inpatient setting where they are needed through 30min to 1 hour in-person consultations with the patient. The location of the intervention will be at the three hospital sites for the study setting (Princess Alexandra Hospital, Royal Brisbane and Womens Hospital, and Townsville Univeristy Hospital) for inpatient care, and over telephone or video for outpatient follow-up consultations post-discharge. Follow-up consultations may be completed in the participant's home if this is appropriate and preferred. If the participant is identified as a First Nation's patient, the indigenous healthcare worker may be required to support the pharmacist consultation as care will need to be adapted to ensure a culturally safe and appropriate transition of care service.