Compliance with guidelines for continuity of care in therapeutics from hospital to community

Objectives: io evaluate compliance with the Australian Pharmaceutical Advisory Council's National guidelines to achieve the continuum of quality use of medicines between hospital and community. Design: Descriptive survey, based on questionnaires filled out by general practitioners, of a sample of patients following recent discharge from public hospitals, collated with hospital record reviews for a 20% subsample of the patients. Participants and setting: 357 GPs practising within the postcode boundaries of the South East Sydney Area Health Service were randomly selected to take part in the survey. Of 219 GPs who agreed to participate, 106 completed questionnaires on 203 patients. For a subsample of 38 patients, hospital records were reviewed and compared with the GP survey data. Results: For 52% (105/203) of all patients the GP was not notified of hospital admission. Medication management was documented in the discharge plan for 13% (5/38) of the subsample. Communication in both directions between GP and hospital about medications was recorded for 13% (5/38) of the subsample. Consultation with the GP about the patient's medication during the hospital stay occurred for 11% (22/203) of all patients and 24% (9/38) of the subsample. Ninety-one per cent of patients (185/203) were discharged with sufficient medication to last until they saw their GP. Fewer than 10% of patients received all the information the Guidelines require. For 33% (66/203) of the patients, GPs considered there was at least one barrier leg, language, cultural) to understanding the medication regimen. Conclusions: Compliance with the Guidelines is not good at present. Their acceptance may be strengthened by formulating specific target indicators. A minimum indicator would be notifying the GP of three out of four matters: the patient's admission; medications on discharge; medication changes; and followup arrangements.