Patients that take many medications, particularly patients with impaired cognition or limited knowledge, often have problems adjusting to post-hospital medication regimens.

As a result, some revert to previous medications, or take some combination of new and old medicines.

To prevent this problem, avoid making major changes to the patients "home meds" unless there are clear indications for doing so.

If major changes are made, communicate these clearly to patient, family, and continuing care providers.

In homebound patients, use of home health care, again with clear communication, can be beneficial when multiple medication changes are made.

• Avoid changing outpatient regimen unless you have clear indications.



• Effectively communicate changes to patient, family, and outpatient care.



• Use home health care in homebound patients with multiple medication changes.