Background and importance Clinical pharmacist services (CPS) are increasingly used in optimising patients’ medications at hospital admission and during the hospital stay. However, some drug related problems (DRPs) are not always solvable in the hospital, but community pharmacists (CPs) and hospital pharmacists (HPs) may collaborate to follow-up and resolve these DRPs post discharge.

Aim and objectives To analyse the nature and type of DRPs referred by HPs to a CP for follow-up post discharge.

Material and methods The study was conducted on four acute hospital wards in Region Zealand, involving 11 HPs. The HPs conducted their usual CPS at admission and wrote a referral meant for the CP with information about DRPs to be followed up post discharge. Additionally, data were gathered on patient age, gender and number of medications, and analysed using descriptive statistics. The identified DRPs were classified according to the PCNE-DRP Basic Classification (V.9.1). In addition, the referrals were analysed and categorised into themes.

Results The HPs made a total of 132 referrals in the period from October 2019 to March 2020. The majority of patients were ≥50 years old (88%) and took an average of 10 (0–23) medications. On average, 1 (1–8) DRP was identified per referral. The most used combination of the P, C and I codes where P1 (treatment effectiveness), C7 (patient related) and I2 (intervention on patient level). The ATC codes most often involved in the identified DRPs were R03, A02 and N02. Six themes were identified from the qualitative analysis ‘counselling on medication use’, ‘non-adherence’, ‘medication discrepancies’, ‘dialogue with the general practitioner’, ‘referral to existing community pharmacy services’ and ‘other’.

Conclusion and relevance HPs identify various DRPs to be referred to the CP post discharge. The DRPs were related to the patient, especially to adherence and correct administration of devices meant for respiratory illnesses. Additionally, the HPs were aware of existing services that might be used to solve the DRPs post discharge. Under normal circumstances, these DRPs might not have been identified after discharge in the community pharmacy, which highlights the importance for more collaboration between HPs and CPs in care transitions

Conflict of interest No conflict of interest