title: [The dilemma of discharge medication. A multicentre cohort study on distribution of discharge medication and counseling by the hospital pharmacist in comparison to current practice].
abstract: BACKGROUND
  Today medication gaps are inevitable at discharge from the hospital and patients are insufficiently educated about their medication.
  
  
  METHODS
  The rate of medication gaps and extent and quality of medication counseling were investigated in a prospective comparative study at five different hospitals. In a consecutive manner 847 patients were observed using current practice and 618 patients with a hospital pharmacist involved. Perception of patients, their general practitioners (GP) and community pharmacists with the different discharge procedures was analyzed by meansof questionnaires.
  
  
  RESULTS
  Using current practice 24% of patients missed newly prescribed drugs at discharge. Medication gaps occurred according to patients'or GPs'reports in 10% or 22% of patients, respectively. 12% of patients were neither educated in the hospital nor in private setting about their medication. 22% of patients were not or only partially satisfied with the information received. Patient education, supported by a medication schedule and distribution of discharge medication by hospital pharmacists proved to be feasible and beneficial for patients and GPs. Medication gaps were significantly reduced to 4%. All patients received medication counseling at discharge and quality of education significantlyimproved.
  
  
  CONCLUSIONS
  Distribution of discharge medication and counseling of patients bya hospital pharmacist are suitable measures in order to bridge medication and information gaps. Changes in healthcare legislation are necessary in order to implement the hospital pharmacy service.
authors.affiliation: Klinische Pharmazie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz. claudia.mildner@unimedizin-mainz.de
authors.forename: C
authors.initials: C
authors.lastname: Mildner
authors.forename: I
authors.initials: I
authors.lastname: Krämer
mesh_terms: D015331:Cohort Studies; D003299:Cooperative Behavior; D058006:General Practice / Q000331:legislation & jurisprudence*; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D010351:Patient Discharge / Q000331:legislation & jurisprudence*; D010353:Patient Education as Topic; D010607:Pharmacy Service, Hospital / Q000331:legislation & jurisprudence*; D055656:Prescriptions; D012017:Referral and Consultation / Q000331:legislation & jurisprudence*