Table 1.

Illness factors challenging continuity of care

Challenges to continuity	Case scenario	Potential solutions
Chronic illness	Atrial fibrillation, diabetes	Clinical practice guidelines
Complex management	Failure to carry out an evidence-based treatment in which benefit outweighs risks	Patients and providers require access to information: patient counselling, educational material, pharmacist teaching or Internet resources
		Search for preparation not needing INR monitoring
Complex regimen	Polypharmacy	Use of once a day and combination preparations where possible
	Warfarin treatment, narrow therapeutic index, minor and major side effects	Pharmacist assistance
Side effects	Minor bleeding with warfarin	Information about side effects and what to do if occur
Drug interactions	Herbal and ibuprofen	Pharmacists, nurses, and physicians are aware of complete medication list
		Automated drug interaction detection
		Patient education regarding potential drug interactions including over-the-counter and herbals
Co-morbidity	Co-existent hypertension, diabetes, osteo-arthritis	Allow for greater clinic contact time and remuneration for care of patient with multiple medical problems