[A systematic review of therapy coordination between primary and specialist care]

Abstract

Objectives: To evaluate existing information on questions of therapy coordination between primary and hospital care and to identify activities with positive results that could be adapted at the local level.

Design: Systematic review.

Data sources: MEDLINE, SIETES, and Cochrane systematic review databases were searched for articles published between January 1990 and August 2005.

Selection of studies: Those conducted in countries with a National Health Service. Thirty-six studies were included: a) observational studies on drug prescription for patients moving between primary and specialist care (18 studies); b) studies of the views of health professionals: review and consensus articles and editorials (7 articles); qualitative studies (4 articles); c) intervention studies (7 studies). Four-hundred and thirty-one studies were excluded.

Results: The most common problems were: lack of information for patient follow-up, disagreement in drug selection, increases in costs due to hospital stays and difficulties in assuming clinical responsibilities. The solution put forward was that a unified policy of common medicines and budgets is essential. Little information was available on the studies that posed or evaluated interventions to improve therapy coordination. Conditions with the most information available were heart failure, diabetes mellitus, asthma, high blood pressure, and anticoagulant treatment.

Conclusions: The creation of pharmacotherapy committees, involving professionals belonging to both primary and specialist care, was proposed. These committees would adapt for local use protocols and clinical practice guidelines, in line with the prescription quality standards of primary care.