Less Is More: Optimized Pharmacotherapy With Improved coNtinuity of CarE in hospitaLized oLder peOple

"A structured medication review with improved transitional care and multidisciplinary collaboration.~TMPC consists of the following four elements:~1. A structured pharmacotherapeutic analysis~2. A transitional multidisciplinary discussion.The treating physician in the hospital will be involved. The general practitioner and community pharmacist will be consulted.~3. An interview and discussion with the patient and/or legal representative by a member of the Pharmacotherapy-team, which will be performed before the patient is discharged from the hospital.~4. A discharge note with the pharmacotherapeutic care plan. This will be sent to the community pharmacist and the general practitioner."