International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 813–820 | Cite as

Communicating medication changes to community pharmacy post-discharge: the good, the bad, and the improvements

  • Rachel UrbanEmail author
  • Evgenia Paloumpi
  • Nooresameen Rana
  • Julie Morgan
Research Article


Background Communication between hospital and community pharmacists when a patient is discharged from hospital can improve the accuracy of medication reconciliation, thus preventing unintentional changes and ensuring continuity of supply. It allows problems to be resolved before a patient requires a further supply of medication post-discharge. Despite evidence demonstrating the benefits of sharing information, community pharmacists’ willingness to receive information and advances in information technology (particularly electronic discharge medication summaries), there is little published evidence to indicate whether communication has improved over the last 15 years. This study aimed to explore community pharmacists’ experience of information sharing by and with their local hospital and GP practices. Objectives (1) To establish the extent to which community pharmacies currently receive discharge medication information, and for which patients.(2)To determine community pharmacy staff opinion on where and how current communication practice could be improved. Setting Community Pharmacies in one Primary Care Organisation (PCO) in England. Method Semi-structured interviews conducted during visits to community pharmacies. Main outcome measure Reported receipt of discharge medication information from hospitals and general practices. Results A total of 14 community pharmacies participated. Current provision of information to community pharmacies from hospitals regarding medication changes at discharge was reported to be inconsistent and lacking in quality. Where information was received it was predominantly for patients who receive their medicines in monitored dosage systems (MDS) rather than for the general population of patients. Some examples of “notable practice” were reported. Conclusion Community pharmacists received post-discharge information rarely and mainly for patients where the hospital perceived the patient’s medication issues as “complex”. Practice was inconsistent overall. These findings suggest that the potential of community pharmacists to improve patient safety after discharge from hospital is not being utilised.


Communication Community pharmacy Hospital discharge Medicines reconciliation Qualitative research Seamless care United Kingdom 



We would like to thank Abdulla Hamed and Zafir Patel for contributing to the data collection, John Tucker and Peter Marshall for reviewing the interview schedule and all the pharmacists and staff who agreed to participate in the study. Also a special thanks to Alison Blenkinsopp who reviewed and advised on the content of the paper.


No external funding was received for this study.

Conflicts of interest


Supplementary material

11096_2013_9813_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


  1. 1.
    Brackenborough S. Views of patients, general practitioners and community pharmacists on medication related discharge information. Pharm J. 1997;259:1020–3.Google Scholar
  2. 2.
    Argyle M, Newman C. An assessment of pharmacy discharge procedures and hospital communications with general practitioners. Pharm J. 1996;256(6898):903–5.Google Scholar
  3. 3.
    Munday A, Kelly B, Forrester JW, Timoney A, McGovern E. Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care? Br J Gen Pract. 1997;47(422):563–6.PubMedGoogle Scholar
  4. 4.
    Brown J, Brown D. Pharmaceutical care at the primary-secondary care interface in Portsmouth and South East Hampshire. Pharm J. 1997;258:280–4.Google Scholar
  5. 5.
    Duggan C, Feldman R, Hough J, Bates I. Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharm Pract. 1998;6:77–82.CrossRefGoogle Scholar
  6. 6.
    Choo G, Cook H. A community and hospital pharmacy discharge liaison service by fax. Pharm J. 1997;259:659–61.Google Scholar
  7. 7.
    Eadon H. Use of pharmacy discharge information for transplant patients. Pharm J. 1994;253:314–6.Google Scholar
  8. 8.
    Pegrum S. Seamless care: the need for communication between hospital and comunity pharmacists. Pharm J. 1995;254:445–6.Google Scholar
  9. 9.
    Brookes K, Scott MG, McConnell JB. The benefits of a hospital based community services liaison pharmacist. Pharm World Sci. 2000;22(2):33–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Wilcock M, Lawrence J. Is there a role for community pharmacists in identifying discrepancies in medication histories for patients admitted to hospital. Pharm J. 2004;272:253–6.Google Scholar
  11. 11.
    Cook H. Transfer of information between hospital and community pharmacy: a feasibility study. Pharm J. 1995;254:736–7.Google Scholar
  12. 12.
    Oborne CA, Dodds L. Seamless pharmaceutical care: the needs of community pharmacists. Pharm J. 1994;253:502–6.Google Scholar
  13. 13.
    Sexton J, Ho YJ, Green CF, Caldwell NA. Ensuring seamless care at hospital discharge: a national survey. J Clin Pharm Ther. 2000;25(5):385–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith L, McGowan L, Moss-Barclay C, Wheater J, Knass D, Chrystyn H. An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital. Br J Clin Pharmacol. 1997;44:163–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Hugtenburg JG, Borgsteede SD, Beckeringh JJ. Medication review and patient counselling at discharge from the hospital by community pharmacists. Pharm World Sci. 2009;31(6):630–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.PubMedGoogle Scholar
  17. 17.
    Livingstone C. Onwards and upwards with target MURs. Pharm J. 2010;284:57–60.Google Scholar
  18. 18.
    NHS Employers. Community pharmacy services. Guidance for hospitals. 2012. Ref: EGUI11001. Accessed at on 11 Sept 2012.
  19. 19.
    Cairns C. Pharmacist admission and discharge checklists: how should they be used? Pharm J. 1994;253:770–3.Google Scholar
  20. 20.
    Cochrane RA, Mandal AR, Ledger-Scott M, Walker R. Changes in drug treatment after discharge from hospital in geriatric patients. BMJ. 1992;305(6855):694–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Mottram D, Slater S, West P. Hospital discharge correspondence—how effective is it? Int J Pharm Pract. 1994;3:24–6.CrossRefGoogle Scholar
  22. 22.
    Pope PC. Analysing qualitative data. BMJ. 2000;320(7227):114–6.PubMedCrossRefGoogle Scholar
  23. 23.
    NHS Information Centre for Health and Social Care. General pharmaceutical services in England 2001-02 to 2010-11. Prescribing and primary care services, November 2011. 2011. Accessed at on 11 Sept 2012.
  24. 24.
    NICE & NPSA. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. 2007. ISBN 1-84629-563-7. Accessed at on 11 Sept 2012.
  25. 25.
    Grimes TC, Duggan CA, Delaney TP, Graham IM, Conlon KC, Deasy E, et al. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. Brit J Clin Pharmacol. 2011;71(3):449–57.CrossRefGoogle Scholar
  26. 26.
    Royal Pharmaceutical Society (RPS). Keeping patients safe when they transfer between care providers—getting the medicines right. Good practice guidance for healthcare professions. 2011. Accessed at on 11 Sept 2012.
  27. 27.
    Tompson AJ, Peterson GM, Jackson SL, Hughes JD, Raymond K. Utilizing community pharmacy dispensing records to disclose errors in hospital admission drug charts. Int J Clin Pharm Ther. 2012;50(9):639–46.CrossRefGoogle Scholar
  28. 28.
    Barnsteiner JH. Medication reconciliation: transfer of medication information across settings-keeping it free from error. AJN. 2005;105(3 Suppl):31–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Scottish Intercollegiate Guideline Network (SIGN). The SIGN discharge document. (2012). Available at Accessed May 2013.
  30. 30.
    National Prescribing Centre (NPC). Medicines reconciliation: a guide to implementation. 2008. Available at Accessed Feb 2013.
  31. 31.
    Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Royal Pharmaceutical Society (RPS). Keeping patients safe when they transfer between care providers—getting the medicines right. Prescribing and Primary Care Services, November 2011. Picton C & Wright H. 2012. Accessed at on 11 Sept 2012.
  33. 33.
    DH. The Power of Information: Putting all of us in control of the health and care information we need. Ref: 17668. DH London. 2012; May 2012.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Rachel Urban
    • 1
    • 2
    • 3
    Email author
  • Evgenia Paloumpi
    • 1
  • Nooresameen Rana
    • 1
  • Julie Morgan
    • 1
  1. 1.School of PharmacyUniversity of BradfordBradfordUK
  2. 2.Bradford Institute for Health ResearchBradford Teaching Hospitals NHS Foundation TrustBradfordUK
  3. 3.Pharmacy DepartmentBradford Teaching Hospitals NHS Foundation TrustBradfordUK

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