Dispensing Multidose COPD Inhalers at Discharge Improves Medication Adherence

Multidose medication dispensing at discharge (MMDD) involves supplying products that have been partially used during hospitalization to ensure continuity of care.

MMDD has been shown to reduce medical waste by up to 70% and is a promising method for reducing readmissions related to chronic obstructive pulmonary disease (COPD). Patients who are discharged empty-handed may incur a $20 co-pay, which has been shown to increase Medicare beneficiaries’ medication nonadherence by 31%.

However, pharmacist intervention can reduce 30- and 60-day readmissions with accompanying cost savings, according to a study published in the American Journal of Health-System Pharmacists.

The study, which was conducted at an academic community hospital system in Texas between 2011 and 2014, enrolled a primarily uninsured, indigent population.

The researchers looked at inhaler adherence after hospital discharge and 30-day all-cause readmission rates before and after MMDD implementation. Secondary objectives included direct cost savings due to MMDD implementation and 60-day all-cause hospital readmission rates.

Cost savings were driven mainly by preventing admissions rather than direct pharmacy savings.

Pharmacist-driven proper inhaler technique education was effective but dwarfed by the effect of increased access to medications.

All patients in the post-intervention group were considered adherent, since each of them was given the remainder of their multidose inhaler when discharged.

Readmission rates may have been underestimated due to patients being admitted to facilities outside the study’s health system—a problem often cited in studies of readmissions. However, this largely self-paying population tends to seek care more frequently within their system than the population at large.

Inhaler cost was lower at system-owned pharmacies, which encouraged patients to seek care at pharmacies where data were being collected. Some patients may have purchased inhalers at a higher cost outside of the system, so they would have been missed in the tabulations.

Overall, this study showed improved medication adherence from MMDD was a key driver in cost savings primarily by avoidance of 30- and 60-day hospital readmission. These results are encouraging and worthy of follow-up and replication at other sites.