Transitions of Care: A Vulnerable Time for Older People and Key Opportunity for Pharmacist Intervention.

Abstract

Challenges arise for older people as medications are started, discontinued, and altered during transitions of care. A perfect storm of chaos can start with a simple admission to the hospital, referral to a specialist, or visit to the emergency room. The term transitions of care refers to a patient moving from one health care setting or level of care to another. As medication regimens are changed as a patient transitions across care settings, medication discrepancies and errors may occur, often resulting in negative outcomes such as adverse drug events, nonadherence, polypharmacy, and hospital readmissions.