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OBJECTIVE To assess the completeness of medication-related information in hospital discharge letters and in general practitioner (GP) overviews after discharge DESIGN Observational study METHODS Patients discharged from the departments of neurology, cardiology, pulmonology and internal medicine were included after medication reconciliation was performed by pharmaceutical consultants In liaison with the resident and the patient they made a transitional medication overview (TMO) that contained all pharmacotherapy and allergies The resident was urged to download the TMO information into the discharge letter to inform the GP However, the resident could include a self-made medication list instead The TMO information was considered the gold standard and was compared with the medication-related information in the collected discharge letters and GP overviews after discharge regarding correct medications and allergies Descriptive data analysis was used RESULTS 99 patients were included The resident had downloaded the TMO information in 71 discharge letters 172%) However, medication-related information was complete in 62 letters (63%) as residents adjusted the TMO information or included a self-made medication list which was incomplete Of GP overviews 16 (16%) were complete Communication of medication-related information increased documentation by the GP, but the medication history could still be incomplete, mainly regarding medication changes and allergies CONCLUSION Medication-related information is lost in discharge letters and GP overviews despite in-hospital medication reconciliation This may result in discontinuity of care More m-hospital training is needed and future studies should determine the effect of electronic infrastructures on improving information transfer and continuity of pharmaceutical care.

OBJECTIVE To assess the completeness of medication-related information in hospital discharge letters and in general practitioner (GP) overviews after discharge DESIGN Observational study METHODS Patients discharged from the departments of neurology, cardiology, pulmonology and internal medicine were included after medication reconciliation was performed by pharmaceutical consultants In liaison with the resident and the patient they made a transitional medication overview (TMO) that contained all pharmacotherapy and allergies The resident was urged to download the TMO information into the discharge letter to inform the GP However, the resident could include a self-made medication list instead The TMO information was considered the gold standard and was compared with the medication-related information in the collected discharge letters and GP overviews after discharge regarding correct medications and allergies Descriptive data analysis was used RESULTS 99 patients were included The resident had downloaded the TMO information in 71 discharge letters 172%) However, medication-related information was complete in 62 letters (63%) as residents adjusted the TMO information or included a self-made medication list which was incomplete Of GP overviews 16 (16%) were complete Communication of medication-related information increased documentation by the GP, but the medication history could still be incomplete, mainly regarding medication changes and allergies CONCLUSION Medication-related information is lost in discharge letters and GP overviews despite in-hospital medication reconciliation This may result in discontinuity of care More m-hospital training is needed and future studies should determine the effect of electronic infrastructures on improving information transfer and continuity of pharmaceutical care.