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Asthma medications at discharge may prevent future ED visits
An intervention that increased the proportion of patients discharged with asthma medications decreased the amount of unplanned ED visits after discharge, according to recent research in Pediatrics.
“A discharge medication delivery [Meds-in-Hand] service created in partnership with the hospital-owned outpatient pharmacy was most successful at ensuring that a high proportion of patients were discharged in possession of their prescribed outpatient medications,” Jonathan Hatoun, MD, MPH, of Boston University School of Medicine and Boston Medical Center, and colleagues wrote.
The researchers developed and completed three interventions with the primary outcome of increasing the proportion of pediatric patients discharged with asthma medications. The first intervention required residents to write prescriptions faster (at least 1 day before discharge) and recommended that parents pick up medications at a local pharmacy or the hospital outpatient pharmacy. The second intervention implemented special fax coversheets for pharmacists, to expedite the distribution of pediatric asthma medication at the in-hospital pharmacy. The third intervention established a system of delivering prescriptions from the hospital outpatient pharmacy to the patient’s room, where co-pays were accepted via cash or a mobile payment system. This study was conducted in the pediatric ward of Boston Medical Center during a 2 year period.
Each intervention cycle was developed based on feedback from the previously completed intervention. The researchers found that parents were uncomfortable leaving the hospital to visits an unfamiliar pharmacy and therefore developed the second intervention, through which participants would not have to leave the hospital. The researchers then noted that parents were uncomfortable leaving the room of their sick child and preferred picking up medication after discharge to avoid this scenario. The in-room delivery intervention yielded the best results, and also allowed pharmacists and doctors to educate patients and parents on proper medication use in the patient’s room.
Each intervention increased the proportion of patients discharged with medications in hand: the first intervention achieved this in 40% of participants, the second in 59% and the third in 75%. Of the 124 pediatric patients studied, 77 were discharged with medications in-hand.
The researchers found that patients discharged with medications were significantly less likely to return to the ED within 30 days of discharge (OR= 0.22; 95% CI, 0.05-0.99). However, there was no statistically significant impact on the likelihood of readmission (OR = 0.41; 95% CI, 0.08-2.1) or visits to primary care soon after discharge (OR = 0.81; 95% CI, 0.38-1.71).
“Although more evidence on the impact of being discharged in possession of discharge medications is needed, a service that provides admitted patients with their outpatient medications before they leave the hospital has many potential benefits,” Hatoun and colleagues wrote. “Additional areas of exploration could include how the Meds-in-Hand service affects the patient experience, hospital finances, and clinical outcomes for other medical conditions.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
