To the Editor: The article by Mant et al1 and the letters following its publication focus attention on a long-standing problem that, despite concerted efforts by governments, healthcare providers and other stakeholders to address it, remains a major obstacle to effective and appropriate continuity of pharmacotherapy following discharge from hospital.

There is little doubt that many of the difficulties arise as a result of poor communication between hospitals and general practitioners. This is further exacerbated by a lack of standard protocols for the preparation and dissemination of discharge summaries. Nowhere is this more evident than in the case of residents of aged-care facilities returning from hospital with radically changed medication regimens.

To establish appropriate communication channels, Mant et al mention hospital GP liaison officers.1 New canvasses the potential problems and suggests sensible solutions, including the involvement of community pharmacists.2

However, every hospital has a readymade resource that requires only a set of formal protocols and procedures to make it function — clinical pharmacists. Clinical pharmacists view every patient's chart at least once every day. The chart not only provides information for dispensing, but also gives pharmacists an opportunity to monitor Quality Use of Medicines and communicate with hospital doctors regarding existing or potential problems.

By the time the "prescription" is processed and the medication dispensed, quality issues have been addressed and a detailed record created. From the dispensing record, a "medication profile" could be generated. This can provide the patient with consumer information regarding each drug, its dose, frequency of administration and mode of action, and can act as an accurate and up-to-date discharge summary. In addition, a clear, legible copy can be faxed, mailed or electronically transmitted to the patient's GP, pharmacist, specialist, allied healthcare professional, rehabilitation hospital or aged-care facility.

Our organisation provides medication management services to a large number of aged-care facilities as well as to public and private hospitals, and correctional facilities. Quality Use of Medicines monitoring constitutes a vital part of our clinical pharmacists' duties. It provides an effective, accurate and timely method of communicating detailed discharge summaries (which have undergone thorough Quality Use of Medicines screening) to GPs and other interested parties.

By including hospital clinical pharmacists in the Quality Use of Medicines monitoring and evaluation process, meaningful information can be obtained, appropriate judgements made, effective communication conducted and optimum pharmacotherapy outcomes achieved.