An Underused Competence: Clinical Pharmacists' Experiences of Writing Referrals in Transitions of Care.

Older people are at increased risk of medication-related problems, which may be identified by clinical pharmacists during hospital medication reviews. Some problems are better managed in primary care, where follow-up is possible. Medication-related communication by pharmacists may improve information transfer in care transitions, but this practice remains uncommon in Sweden. This qualitative study explored clinical pharmacists' experiences and perceptions of writing referrals to primary care. Data were collected through four focus groups and three supplementary interviews with 19 clinical pharmacists from hospitals and primary care, and analysed using qualitative content analysis. Eleven participants had experience writing referrals, although none did so regularly. Four categories emerged: role of the pharmacist, current work procedures, pharmacist-physician relationship and facilitating factors. Pharmacists believe they can contribute to patient safety through involvement in transitions of care. An overall concept of an underused competence permeated the categories. Referrals identifying medication-related problems are hindered by limited pharmacist integration into the healthcare team and limited continuity. Writing referrals was considered a new procedure requiring collaboration with unfamiliar partners. Organisational changes, including increased pharmacist continuity and clearer pharmacist roles, are needed to implement referral practices. Further research is needed to evaluate effects on medication treatment and patient outcomes.