A Quality Use of Medicines program for continuity of care in therapeutics from hospital to community

To the Editor: Mant et al1 explore an important aspect of the quality use of medicines in their study on the continuity of medicines from hospital to community. Their study on compliance with an agreed minimum dataset for patient medication information exchange between hospitals and general practitioners provides a useful perspective of an approach to systems change. I wish to point out a number of limitations that may have affected their results and make some suggestions to improve the quality use of medicines.

GPs were audited on whether they provided medication information to hospitals. Many GPs work part-time. There is the possibility that the medical practice was contacted by a hospital employee, who obtained the information from a doctor other than the patient's usual GP.

The audit covered discharge summaries received by the GP by fax. Although faxing discharge summaries is convenient, there are potential problems with this method. There are the possibilities of dialling a wrong number, and faxed discharge summaries (particularly handwritten ones) may be difficult to read, which could also result in medication errors. In addition, a discharge summary may have been posted to the practice instead of faxed, which would under-report the true percentage of GPs who received the information.

It is not uncommon for patients to have multiple GPs.2 However, it is my experience that only one GP is documented in the patient's medical file. This issue could have influenced the results of the GP audit and would be a further factor complicating the continuity of medicines from hospital to the community.

The authors mention the introduction of GP liaison officers to facilitate the notification of GPs about patient admissions and the rationale for medication changes. They do not report any other measures that they plan to introduce to improve their results. Given that systems problems have multifaceted answers, further expansion on what other steps could be taken would have been a useful addition to their article. I suggest that it would have been appropriate to include a broader range of key stakeholders in the workshops, such as community pharmacists and patients. In addition, a computerised hospital prescribing system could be integrated with an on-line evidence-based clinical guide to prescribing to assist in optimal medication selection. This could also be used to generate a discharge medication list that was automatically sent to the patients' GPs. Such an approach would reduce errors and improve outcomes.3,4