Dispensing Meds Before Hospital Discharge May Reduce Readmissions

Patients who leave the hospital without their prescriptions in hand following an asthma-related visit are substantially more likely to be readmitted.

According to the US Centers for Disease Control and Prevention, 6.3 million US children have asthma, which is also the second-most costly disease in children in the United States. Emergency department admissions comprise a significant portion of these costs, although they are thought to be avoidable in many cases.

A recent study published in Pediatrics investigated whether a medication discharge program for patients with asthma would improve outcomes and cut health-system costs.

The baseline was 0% of patients leaving the hospital with their necessary medications in hand. By the end of the study period, 75% of patients were discharged from the hospital with their prescriptions.

“In a subset of patients for whom all insurance claims were available, those discharged with meds in hand had lower odds of all-cause representation to the emergency department within 30 days of discharge, compared with patients discharged with usual care,” the authors concluded.

The multidisciplinary improvement team included a hospital pharmacist who provided patients with the opportunity to learn how to use their medications effectively. The results of the study prompted Boston University Medical Center to initiate new discharge process improvements, including the “Meds in Hand” program.

Robert Miranda, PharmD, manager of the Yawkey Outpatient Pharmacy at Boston Medical Center, told Pharmacy Times that patients were appreciative of the Meds-in-Hand program, which provided pediatric patients with asthma the medications they needed before they were discharged.

“Most patients will comment on how much time this service has saved them,” Dr. Miranda said.

Although the study specifically investigated children who were given asthma medications, the findings generally suggested that in-hospital prescriptions may improve adherence and outcomes for patients of all ages.

"While our study was small, it shows that a fairly simple intervention can be administered by the inpatient team to help decrease future emergency department visits for patients with asthma," said Jonathan Hatoun, MD, a former researcher at Boston Medical Center and lead author, in a press release. "We might expect similar results for other diseases, though more studies need to be done."

Other studies involving different disease states have investigated the extent to which dispensing medications at the time of discharge improves patient outcomes.

For example, one study published in the American Journal of Health-System Pharmacists found that patients with chronic obstructive pulmonary disease similarly benefited from multidose medication dispensing at discharge (MMDD). It showed that improved medication adherence from MMDD was a key driver in cost savings primarily through avoidance of 30- and 60-day hospital readmission.