Transitions of care in services within and between organizations are a potential source of medication-related problems. These include errors in medication reconciliation, which can lead to patient misunderstanding regarding their medication regimen. Health systems have increasingly focused on improving transitions of care to enhance patient outcomes and decrease the risk of adverse events and/or hospital readmissions. The clinical pharmacy team of the Virginia Garcia Memorial Health Center (VGMHC) collaborated with the pharmacy department and discharge planners of a local community hospital. The goal of this collaboration was to streamline the transition of care between the two organizations for new referrals of uninsured, complex patients that were recently hospitalized and needing to establish care with a primary care provider at a federally qualified health center. This article will further describe the process of collaboration between a local community hospital and a federally qualified health center targeting a specific population for transitions of care.
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