Ambulatory Medication Reconciliation Following Hospital Discharge

Inclusion Criteria

• •Patients admitted to BWH or MGH who plan to follow up with a PCP in one of 12 primary care practices affiliated with BWH or MGH.
• •Patients will need to meet the following criteria:
• •* 1\) be 55 years or older,
• •* 2\) be admitted to the participating delivery system's hospital during the study period for a non-psychiatric condition,
• •* 3\) have no plans to enter hospice,
• •* 4\) be discharged back to the community,
• •* 5\) be prescribed 5 or more medications at discharge, including at least one of the following:
• •* antibiotics,
• •* insulin,
• •* antihypertensives,
• •* anti-rejection,
• •* antiarrhythmics,
• •* inhalers,
• •* antiepileptics,
• •* antianginals,
• •* pain medications,
• •* oral hypoglycemics,
• •* steroids,
• •* anticoagulants.
• •* These drugs were selected because they require close monitoring, increase risk for drug-drug interactions, have a narrow therapeutic window, or are known to increase risk for ADEs in the older adult population