Specially trained community pharmacists in Canada, using a pharmaceutical care-based protocol, can produce impressive improvements in clinical, economic and humanistic outcome measures in asthma patients. The health care system needs to produce incentives for such care.

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S eamless care has been identified by many health authorities as an important aspect of modern health care. 1,2 Studies 3,4 have shown that at least 50% of drug-related problems experienced by patients are due to inappropriate prescribing or nonadherence to therapy. In addition, many drug-related problems occur because healthcare professionals have inadequate access to comprehensive patient medication profiles. This is a result of the lack of a support system to maintain integration and continuous communication of information between healthcare professionals.Presently, 10% of all emergency department admissions and 25% of hospital admissions in the elderly population can be directly attributed to drug noncompliance and drug misadventure. Nearly half of the elderly patients who are discharged from the hospital will be readmitted within two months due to medication problems. 5,6 This increases the cost burden on the healthcare system and works against the trend of reducing costs by processing patients faster in the acute care setting. Studies 7 have shown that there is a change made to nearly 50% of patient medications prior to hospital discharge, and up to 61% of patients may experience potential drug-related problems once they are discharged. OBJECTIVE:To determine whether a new discharge prescription form which integrates admission medications, in-hospital changes, and discharge medications could enhance the accuracy of information in patient profiles in community pharmacies after hospital discharge. DESIGN: Nonrandomized, prospective, multi-site study. SETTINGS: Internal medicine wards of the three teaching hospitals (1200 beds) of the Centre Hospitalier de l'Université de Montréal. SUBJECTS: Patients admitted to the internal medicine wards between January 4 and 31, 1999, at St.-Luc and Notre-Dame Hospitals formed the control group and received a usual discharge form (UD). Those admitted between February 1 and 28, 1999, received the new discharge prescription form (DPF) capturing the list of admission medications and revisions during hospitalization; they served as the experimental group.METHODS: Patient profiles were reviewed to calculate conformity rates of community pharmacy patient profiles after discharge and the rate of overall conformity for each group in the study. Each drug in the patient profile was assessed according to six criteria. Healthcare providers' satisfaction with the DPF was assessed via a written questionnaire. RESULTS:Eighty-nine patients and 669 discharge medications were studied. The patient profiles had a higher conformity rate in the DPF group than in the UD group (82% vs. 40%; p < 0.001); improvement could be attributed to higher conformity rates, particularly for two criteria (medications stopped in hospital and dose changes in hospital). CONCLUSIONS:Integration of admission medications, in-hospital changes, and discharge medications on a single form increases the conformity rates of community pharmacy patient profiles after hospitalization. This tool is well accepted by both pharma...