Background: Discharge letters were routinely sent to the patient's general practitioner (primary care physician, family physician) by a care of the elderly consultant. In the past (the 'old' system), copies were also sent to the patients, or their carer, as well as other healthcare professionals if necessary, but not routinely to pharmacists.
Method: The consultant's practice changed in March 2005 to a 'new' system and the practice-based pharmacists received copies of discharge letters for patients discharged from the two community hospitals. The service change was audited before and after the consultant's change in practice. The pharmacists (n = 4) and the consultant were interviewed to ascertain their views about the 'old' and 'new' systems, and potential barriers and enablers to their work.
Results: Patients were more likely to get the treatment recommended by the consultant as a result of the change in practice: 83% (34/41) compared to 51% (23/45) of patients had treatment plans in their discharge letters implemented. Consultant recommendations were not fully implemented in 7% after compared to 29% before the change in practice which gave a number needed to treat (NNT) for the intervention of four (95% confidence interval, 3-6). All pharmacists and the consultant were very positive about the change, having found the 'old' system haphazard and unreliable. They also felt patients were more likely to get the treatment recommended by the consultant. This was supported by results from the audit. Pharmacists felt more integrated into their local healthcare team and that the change linked the discharge process in secondary care with the existing pharmacist medication review service in primary care. All felt there would be benefit to the patient and value in extending the scheme, without any adverse increase in workload.
Conclusion: Sending discharge letters to pharmacists working in the practice as well as general practitioners can lead to improvements in co-ordination of care and implementation of consultant recommendations for treatment.