Effect of a transitional pharmaceutical care intervention at hospital discharge on registration of changes in medication regimens in primary care

摘要

To the Editor: The medication regimens of many individuals require changes at hospital admission, so the individuals leave the hospital with a medication regimen that differs from that before admission.1"3 The effect of a transitional pharmaceutical care intervention at discharge on intended and unintended medication discrepancies in medication use after hospital discharge was reported in a previous letter.4 In the transition process from secondary to primary care, community pharmacists (CPs) and general practitioners (GPs) often receive insufficient information on changes and especially information on reasons for changes to the medication regimen made during hospitali-sation.1'5'6 Consequently, changes to the medication regimen made during hospitalization may not be implemented in primary care, compromising the individual's safety. Many studies have focused on improving transitional pharmaceutical care, for example, by providing a structured medication overview at discharge,2'5'7"9 but these studies did not investigate whether medication changes are incorporated into the CPs' and GPs' files.