Medication reconciliation is central to safer transitions of care, yet an accurate discharge medication list does not ensure that intended medication changes remain understood, accessible, feasible, or clinically appropriate after discharge. To distinguish medication reconciliation from medication continuity and propose a pharmacist-led framework linking therapeutic intent, information transfer, patient capability, and post-discharge follow-up. This non-empirical model integrates evidence from transition-of-care, medication-safety, communication, patient self-management, pharmacist-intervention, and implementation research. Evidence-supported observations are separated from newly proposed relationships and failure states. Medication continuity is proposed as the longitudinal preservation or deliberate revision and enactment of therapeutic intent across care settings. Four interdependent conditions are distinguished: interpretable therapeutic intent, faithful transfer of the medication plan, sufficient patient or caregiver capability to perform medication work, and follow-up capable of detecting divergence and enabling correction. Pharmacists are positioned as medication-focused coordinators rather than sole owners of prescribing, supply, or patient behavior. Reconciliation should be treated as an essential transition process rather than proof of continuity. The proposed framework requires construct validation, prospective testing, context-sensitive implementation evaluation, and examination across heterogeneous patients and health systems.
