• Hendrik T Ensing, Ellen S Koster, Dasha J Dubero, Ad A van Dooren, and Marcel L Bouvy.
• Utrecht University of Applied Sciences, Research Group Process Innovations in Pharmaceutical Care, Utrecht, The Netherlands; Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; Zorggroep Almere, Outpatient Pharmacy "de Brug 24/7", Almere, The Netherlands. Electronic address: rensing@zorggroep-almere.nl.
• Res Social Adm Pharm. 2019 Mar 1; 15 (3): 267-278.

BackgroundHospital discharge poses a significant threat to the continuity of medication therapy and frequently results in drug-related problems post-discharge. Therefore, establishing continuity of care by realizing optimal collaboration between hospital and community pharmacists is of utmost importance.ObjectiveTo evaluate the collaboration between hospital and community pharmacists on addressing drug-related problems after hospital discharge.MethodsA prospective follow-up study was conducted between November 2013-December 2014 in a general hospital and all affiliated community pharmacies. Adult patients, admitted for ≥48 h to the neurology or pulmonology ward were eligible if they used ≥3 chronic prescription drugs and lived in the community pharmacies' service area. The HomeCoMe intervention program was comprised of medication verification and counseling at admission, medication screening by the hospital pharmacist during admission, outpatient pharmacy discharge consultation and support, and a community pharmacist home visit within one week post-discharge.ResultsThe mean age of the 152 included patients was 67.0 ± 12.6 years and 56.6% were female. A total of 745 DRPs (4.9 ± 2.2 DRPs per patient, range: 0-11) were identified with the need for additional "Education or information" (36.1%) and "Compliance" (16.4%) issues as most common DRP-types. This led to a total of 928 recommendations (6.1 ± 3.0 per patient, range: 1-19) to solve the DRP. The majority of DRPs were identified (83.6%, n = 623) and solved (91.6%, n = 682) by the community pharmacist during the home visit. Furthermore, 52.5% (n = 64) of the DRPs identified during hospitalization were solved during the post-discharge home visit.ConclusionsCollaboration between hospital and community pharmacists from hospital admission to readmission to primary care is crucial to establish continuity of care. A post-discharge community pharmacist home visit is a valuable addition to in-hospital transitional care to identify and solve drug-related problems.Copyright © 2018 Elsevier Inc. All rights reserved.

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