International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 1206–1212 | Cite as

Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews

  • Elien B. Uitvlugt
  • Carl E. H. Siegert
  • Marjo J. A. Janssen
  • Giel Nijpels
  • Fatma Karapinar-ÇarkitEmail author
Research Article


Background Communication and documentation of medication-related information are needed to improve continuity of care. Objective To assess the completeness of medication-related information in discharge letters and post-discharge general practitioner (GP)-overviews. Setting A general teaching hospital in Amsterdam, the Netherlands. Method An observational study was performed. Patients from several departments were included after medication reconciliation at hospital discharge. In liaison with the resident and patient, a pharmacy team prepared a Transitional Pharmaceutical Care (TPC)-overview of current medications, including changes and allergies. The resident was instructed to download the TPC-overview into the discharge letter instead of typing a self-made medication list. Medication overviews were gathered from the GP 2 weeks after the handover of the discharge letter. The TPC-overview (gold standard) was compared with the information in the discharge letter and post-discharge GP-overviews regarding correct medications and allergies. Descriptive data analysis was used. Main outcome measure The number and percentage of complete medication-related information in the discharge letter and the GP-overview were compared to the TPC-overview. Results Ninety-nine patients were included. Medication-related information was complete in 62 (63 %) of 99 discharge letters. Sixteen of 99 GP-overviews (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. Conclusions Medication-related information is lost in discharge letters and GP-overviews post-discharge despite in-hospital medication reconciliation. This could result in discontinuity of care.


Care transitions Continuity of care Hospital discharge Medication errors Medication reconciliation 



We would like to express our gratitude to Piter Oosterhof, Godelieve Ponjee and the pharmaceutical consultants for the collection of data. We also thank the patients, the hospital departments and the general practitioners for their cooperation in this study.

Compliance with ethical standards



Conflicts of interest



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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Elien B. Uitvlugt
    • 1
  • Carl E. H. Siegert
    • 2
  • Marjo J. A. Janssen
    • 1
  • Giel Nijpels
    • 3
  • Fatma Karapinar-Çarkit
    • 1
    Email author
  1. 1.Department of Hospital PharmacySint Lucas Andreas HospitalAmsterdamThe Netherlands
  2. 2.Department of Internal MedicineSint Lucas Andreas HospitalAmsterdamThe Netherlands
  3. 3.Department of General PracticeEMGO Institute VU University Medical CenterAmsterdamThe Netherlands

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