JMIR Publications

ABSTRACT

Background:

Transition of care (TOC) is a high risk period for medication errors due to breaks in continuity as patients move between multiple healthcare professionals, settings, and changing medication regimens. Ineffective communication systems further increase the likelihood of medication harm and hospital readmission. A structured TOC service with tailored, patient specific support may help reduce these risks. Cardiovascular medicines are a major contributor to medication harm, and patients recovering from acute myocardial infarction (AMI) or cardiothoracic surgery (CS) are particularly vulnerable due to complex regimens and frequent in hospital medication changes. Pharmacists, as medication experts embedded within cardiology teams, are well positioned to support these high risk patients, facilitate safer transitions from hospital to home, and provide coordinated post discharge follow up.

Objective:

This study aims to evaluate the impact of a pharmacist-led interdisciplinary TOC service on reducing medication harm for cardiology patients post-AMI or CS.

Methods:

The study will be conducted in two phases: Phase 1: Intervention development will combine scoping review findings with stakeholder input to design an evidence based, co created, culturally relevant intervention, underpinned by implementation science. A risk prediction model will be developed and validated to identify AMI/CS patients at high risk of medication related unplanned readmission within 30 days. Phase 2: The RECARD Trial will use a pre post design across three Australian tertiary hospitals (two metropolitan, one regional) to compare a retrospective usual care cohort with consenting high risk AMI/CS patients receiving the TOC service. High risk patients will receive an individualised bundle of TOC activities to optimise medication management, while others receive usual care. A unique feature of the service is its capacity for hospital clinicians to conduct post discharge home visits for patients needing additional support. The primary outcome for this study is medication-related 30-day hospital readmission. The analysis will consist of multivariable logistic regression. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care. A comprehensive process evaluation will be conducted using the REAIM (Reach Effectiveness, Adoption, Implementation and Maintenance) Framework to enable learnings from the trial to inform sustainable improvements in this field. A patient survey will be administered at the end of the trial to assess patient experience and elicit patient preferences using a Discrete Choice Experiment (DCE).

Results:

The pre-data is currently being collected for patients that discharged from the three hospital sites for the 12-month pre-study period. The post-data intervention began recruitment on 10th December 2025. As of February 2026 we have 191 recruited patients.

Conclusions:

The findings of this study will inform future implementation of a sustainable cardiac TOC model within the Australian healthcare setting. Clinical Trial: The trial has been registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12624001009505p on the 20th of August 2024. URL: ANZCTR and search for study “RECARD”.