• hospital medicine
• delivery of health care
• emergency medicine

The transition from hospital-to-home is a common source of medication-related problems among older adults, some of which lead to hospital readmission. The prevalence of these problems is amplified by an ageing population and an increasing number of unplanned hospital admissions. Clinicians who integrate bundles of simple interventions, such as medication reconciliation, self-management education and telephone follow-up for older patients during discharge are likely to see reductions in hospital readmissions.

Medication-related problems, such as reconciliation errors, patient confusion, inappropriate continuation or discontinuation and inadequate monitoring, are common during the transition from hospital-to-home, especially in older populations.1–3 These problems are known to decrease quality of life and increase hospital readmission and healthcare utilisation.4 5 Improving the quality of care transitions by targeting medication-related problems to reduce …