When patients are discharged from the hospital, they (and their informal caregivers) are given copious amounts of information that must also be communicated to their primary care provider. This qualitative study of primary care and hospital physicians, nurses, and pharmacists highlights several barriers to complete and effective communication between levels of care, particularly regarding geriatric medication safety. Barriers include the large number of complex patients and incongruent expectations of responsibility of primary and hospital providers. Support systems, such as electronic health records, can both enable and hinder communication.

Poor communication between hospital and primary care providers can lead to adverse events, such as hospital readmission. In this study of older adults who required medication-related follow-up with their primary care provider, the discharging provider only sent an adequate request for 60% of patients. Of those patients that did not have an adequate request, 14% had a related hospital revisit within 6 months.

The introduction of clinical pharmacists on inpatient services was positively received by physicians and nurses.

Medication reconciliation revealed a high rate of prescribing and transcribing errors in the discharge medications of elderly patients at a Swedish hospital.

Elderly patients are particularly vulnerable to adverse drug events in both the ambulatory and inpatient settings. This study evaluated the effect of integrating clinical pharmacists into medical teams caring for geriatric patients, a strategy that has been demonstrated to reduce medication errors in prior research. The pharmacists in this study carried out medication reconciliation and education during the hospitalization and communicated specific medication information to patients' outpatient physicians at discharge. This intervention proved effective at reducing readmissions and medication-related emergency department visits and was cost effective. The interventions carried out by the pharmacists in this study, particularly at the time of discharge, are similar to those performed by nurses in prior studies that successfully reduced hospital readmissions.