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1found that more than 1 in 5 patients discharged from a general medicine service to home experienced an adverse event, and 72% of the adverse events were related to medica tions. Other authors have reported similar findings, with adverse drug events being common in the month following discharge. 2 In a recent small Canadian study, 3 77% of patients discharged from an acute care institution had at least one drug therapy problem in the 2 weeks following discharge, linked to gaps in the transfer of medication-related information. The authors of many of these studies have suggested that close follow-up in the first few weeks after discharge could prevent many of these adverse drug events, improving patient outcomes and minimizing the expenditure of health care resources. Intuitively, it seems that patients would benefit from care provided by a pharmacist during this transition period. In this issue of the Journal, Flanagan and others 4 describe a clinical program in which elderly patients received medication management services in their homes after discharge from hospital, with savings in health service resources during the following year. Although many studies have reported positive outcomes from provision of pharmacists’ services in the home, many more have indicated otherwise, including randomized controlled trials 5 that have demonstrated an increase in hospital admissions among patients receiving such in-home care. One suggestion has been that these results may be due to better awareness of health concerns, leading to use of more resources, 5 but other issues need to be considered. Factors that may account for the conflicting evidence in this area include the type of intervention studied, the pharmacist’s qualifications, and whether or not the care was provided within a collaborative context. Studies evaluating clinical pharmacy services in the home have been published over a period of more than 3 decades. During this time, the role of the pharmacist has changed considerably. Earlier literature reflected the pharmacist’s role as a consultant within established home care agencies. The pharmacist did not often work directly with the patient but

Transition from Hospital to Home: Can Pharmacists’ Interventions Improve Patients’ Outcomes?