Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

Main Article Content


Patient Discharge, Continuity of Patient Care, Community Pharmacy Services, Interprofessional Relations, Needs Assessment, Patient Safety, Pharmacists, Switzerland


Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known.

Objective: This study aims to a) Identify community pharmacists’ current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists’ objectives and ideas for discharge optimisation.

Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies.

Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation.

There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services.

Conclusion: Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist’s opinions, appropriate pharmaceutical care is therefore impeded.

Abstract 1773 | PDF Downloads 1122


1. Harris CM, Sridharan A, Landis R, Howell E, Wright S. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf. 2013;9(3):150-153. doi: 10.1097/PTS.0b013e318286f87d

2. Viktil KK, Blix HS, Eek AK, Davies MN, Moger TA, Reikvam A. How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open. 2012;2(6). doi: 10.1136/bmjopen-2012-001461

3. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-167.

4. Neeman M, Dobrinas M, Maurer S, Tagan D, Sautebin A, Blanc AL, Widmer N. Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward. Eur J Intern Med. 2017;38:30-37. doi: 10.1016/j.ejim.2016.11.004

5. Roughead EE, Kalisch LM, Ramsay EN, Ryan P, Gilbert AL. Continuity of care: when do patients visit community healthcare providers after leaving hospital? Intern Med J. 2011;41(9):662-667. doi: 10.1111/j.1445-5994.2009.02105.x

6. Kennelty KA, Chewning B, Wise M, Kind A, Roberts T, Kreling D. Barriers and facilitators of medication reconciliation processes for recently discharged patients from community pharmacists' perspectives. Res Social Adm Pharm. 2015;11(4):517-530. doi: 10.1016/j.sapharm.2014.10.008

7. Geurts MM, van der Flier M, de Vries-Bots AM, Brink-van der Wal TI, de Gier JJ. Medication reconciliation to solve discrepancies in discharge documents after discharge from the hospital. Int J Clin Pharm. 2013;35(4):600-607. doi: 10.1007/s11096-013-9776-x

8. Cavrenne P, Spinewine A. Continuity in patient care upon hospital discharge: evaluation of a clinical pharmacy discharge form for community pharmacists. J Pharm Belg. 2008;63(3):69-72.

9. McElhiney L. Educating the caregiver and community pharmacist to facilitate provision of consistent compounded medications from the inpatient to ambulatory settings. Int J Pharm Compd. 2003;7(5):394-398.

10. Brookes K, Scott MG, McConnell JB. The benefits of a hospital based community services liaison pharmacist. Pharm World Sci. 2000;22(2):33-38.
11. Ni W, Colayco D, Hashimoto J, Komoto K, Gowda C, Wearda B, McCombs J. Impact of a pharmacy-based transitional care program on hospital readmissions. Am J Manag Care. 2017;23(3):170-176.

12. Braund R, Coulter CV, Bodington AJ, Giles LM, Greig AM, Heaslip LJ, Marshall BJ. Drug related problems identified by community pharmacists on hospital discharge prescriptions in New Zealand. Int J Clin Pharm. 2014;36(3):498-502. doi: 10.1007/s11096-014-9935-8

13. Tandjung R, Rosemann T, Badertscher N. Gaps in continuity of care at the interface between primary care and specialized care: general practitioners' experiences and expectations. Int J Gen Med. 2011;4:773-778. doi: 10.2147/IJGM.S25338

14. Adam H, Niebling WB, Schott G. [The information about discharge medication: what do general practitioners need?] Dtsch Med Wochenschr. 2015;140(8):e74-e79. doi: 10.1055/s-0041-101401

15. Bally K, Lingenhel S, Tschudi P. [High-quality hospital discharge summaries - general practitioners expectations]. Ther Umsch. 2012;69(1):5-7. doi: 10.1024/0040-5930/a000243

16. Karapinar F, van den Bemt PM, Zoer J, Nijpels G, Borgsteede SD. Informational needs of general practitioners regarding discharge medication: content, timing and pharmacotherapeutic advice. Pharm World Sci. 2010;32(2):172-178. doi: 10.1007/s11096-009-9363-3

17. Kunz R, Wegscheider K, Guyatt G, Zielinski W, Rakowsky N, Donner-Banzhoff N, Muller-Lissner S. Impact of short evidence summaries in discharge letters on adherence of practitioners to discharge medication. A cluster-randomised controlled trial. Qual Saf Health Care. 2007;16(6):456-461. doi: 10.1136/qshc.2006.020305

18. 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):563-566.

19. Claeys C, Dufrasne M, De Vriese C, Nève J, Tulkens P, Spinewine A. [Information transmission to the community pharmacist after a patient's discharge from the hospital: setting up of a written medication discharge form, prospective evaluation of its impact, and survey of the information needs of the pharmacists]. J Pharm Belg. 2015;(1):42-54.

20. Michel B, Hemery M, Rybarczyk-Vigouret MC, Wehrle P, Beck M. Drug-dispensing problems community pharmacists face when patients are discharged from hospitals: a study about 537 prescriptions in Alsace. Int J Qual Health Care. 2016;28(6):779-784. doi: 10.1093/intqhc/mzw111

21. Rutter P, Ramsbottom H, Fitzpatrick R. Community pharmacist perceptions of delivering post-hospital discharge Medicines Use Reviews for elderly patients. Int J Clin Pharm. 2017;39(1):33-36. doi: 10.1007/s11096-016-0400-8

22. Urban R, Paloumpi E, Rana N, Morgan J. Communicating medication changes to community pharmacy post-discharge: the good, the bad, and the improvements. Int J Clin Pharm. 2013;35(5):813-820. doi: 10.1007/s11096-013-9813-9

23. Al-Rashid SA. Wright DJ, Reeves JA, Chrystyn H. Opinions about hospital discharge information. Part 2. Community pharmacists. J Soc Adm Pharm. 2001;18(4):129-135.

24. De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland Health System Review. Health Systems in Transition. 2015;17(4):1-288.

25. World Health Organization. Joint FIP/WHO Guidelines on Good Pharmacy Practice: Standards for quality of pharmacy services. Geneva 2011. (accessed 9 June 2017).

26. Morgan DL. Focus groups. Ann Rev Sociol. 1996;22(1):129-152.

27. Bundesversammlung der Schweizerischen Eidgenossenschaft. Bundesgesetz über die Forschung am Menschen (Humanforschungsgesetz). 2011. (accessed 18 January 2017).

28. Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(4):655-660.

29. Indermitte J, Erba L, Beutler M, Bruppacher R, Haefeli WE, Hersberger KE. Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland. Eur J Clin Pharmacol. 2007;63(3):297-305. doi: 10.1007/s00228-006-0237-5

30. Zehnder S, Beutler M, Bruppacher R, Ehrenhofer T, Hersberger KE. Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland. Pharm World Sci. 2004;26(4):197-202.

31. Hughes CM, Hawwa AF, Scullin C, Anderson C, Bernsten CB, Bjornsdottir I, Cordina MA, da Costa FA, De Wulf I, Eichenberger P, Foulon V, Henman MC, Hersberger KE, Schaefer MA, Sondergaard B, Tully MP, Westerlund T, McElnay JC. Provision of pharmaceutical care by community pharmacists: a comparison across Europe. Pharm World Sci. 2010;32(4):472-487. doi: 10.1007/s11096-010-9393-x

32. Schweizerischer Apothekerverband pharmaSuisse. RoKa Kurzbericht für das Geschäftsjahr 2014. Bern 2015. (accessed 9 June 2017).

33. Federal Office of Public Health. Kennzahlen der Schweizer Spitäler. Bern: Bundesamt für Gesundheit; 2013. (accessed 9 September 2016).

34. Serfontein J, Dodwell D, Patel P. Psychiatric discharge summaries: what do general practitioners want? Ment Health Fam Med. 2011;8(3):167-171.

35. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94-104. doi: 10.1111/j.1524-4733.2005.04054.x

36. Ensing HT, Koster ES, Berkel PI, Dooren AA. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther. 2017;42(2):170-177. doi: 10.1111/jcpt.12488

37. Kaestli LZ. Amélioration de la continuité des soins pharmaceutiques aux patients pédiatriques sortant de l’hôpital. Geneva: Faculté des Sciences de l’Université de Genève, Université de Genève; 2014.

38. Schwappach DL, Meyer Massetti C, Gehring K. Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety? Int J Clin Pharm. 2012;34(5):765-772. doi: 10.1007/s11096-012-9674-7

Most read articles by the same author(s)