Emergency Department Asthma Medication Delivery Program: An Initiative to Provide Discharge Prescriptions and Education

Abstract

Background:Prescription fill rates for children being discharged from the emergency department (ED) after asthma exacerbations are low, placing the child at risk for additional ED visits or admissions for asthma. This article describes the implementation of an ED asthma prescription delivery service designed to improve pharmacy prescription capture and decrease ED revisit rates.Methods:A core group developed a service to provide asthma prescriptions and education to patients in their ED room before discharge. The project assessed the percent of ED asthma patients who filled ED asthma prescriptions at the hospital outpatient pharmacy, 7-, 14-, and 30-day ED revisit rates, and patient satisfaction.Intervention:Patients/families who chose to participate in the service received asthma prescriptions and education at the ED bedside. Within 1–3 days, ED outreach nurses obtained patient satisfaction survey responses via telephone.Results:There was a statistically significant increase in the number of patients who filled ED asthma prescriptions at the hospital outpatient pharmacy (22.2% versus 33.8%; P < 0.0001). The decrease in 7-, 14-, or 30-day ED revisit rates for patients who received the medication delivery service compared with standard of care was not statistically significant. Patients were satisfied to very satisfied with the service.Conclusion:Postimplementation of a medication delivery program within the ED, there was an increase in the percentage of patients who filled ED asthma medication prescriptions at the hospital outpatient pharmacy. There was no difference in ED revisit rates for patients who enrolled in the prescription delivery service versus standard of care.

Meds to Beds at Hospital Discharge Improves Medication Adherence and Readmission Rates in Select Populations

“…Many existing bedside medication delivery programs in the literature are standalone or targeted to specific populations, mainly based on readmission penalties via HRRP services and discharge diagnoses 12,21,22 . To our knowledge, this is the first study to examine whether reducing travel and financial barriers to obtaining medications reduces readmissions based on comorbidities and medical complexity, as well as primary disease diagnosis.…”

“…Many existing bedside medication delivery programs in the literature are standalone or targeted to specific populations, mainly based on readmission penalties via HRRP services and discharge diagnoses. 12,21,22 To our knowledge, this is the first study to examine whether reducing travel and financial barriers to obtaining medications reduces readmissions based on comorbidities and medical complexity, as well as primary disease diagnosis. We found that providing prescriptions and combining a subsidy to reduce financial burdens lowers readmissions compared with controls and simply providing medicines; focusing on patients with 0 or ≥ 4 comorbidities provided the greatest impact.…”

“…One study showed a nonsignificant decrease in 30-day readmissions after the implementation of a pharmacy program that provided medication reconciliation, education at discharge, medication delivery at the bedside, and follow-up telephone calls 11 . Overall, bedside medication delivery program literature is scant, heterogeneous, and often focused on specific conditions but not overall comorbidities 12–14 . Little data exist on which populations would benefit most from a bedside medication delivery program to facilitate more efficient use of resources.…”

“…11 Overall, bedside medication delivery program literature is scant, heterogeneous, and often focused on specific conditions but not overall comorbidities. [12][13][14] Little data exist on which populations would benefit most from a bedside medication delivery program to facilitate more efficient use of resources. One way to stratify patients is by the complexity of their comorbidities.…”

A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence

“…Researchers in several studies have focused on discharge prescription programs for children with chronic diseases like asthma. 1,12,20 Hatoun et al 1 and Hiteshew et al 12 identified that filling asthma medications in the hospital outpatient pharmacy reduced 30-day ER visit and readmission rates, respectively. Given the multifactorial nature of readmissions and our low baseline readmission rate of ,2%, our study was not powered to detect a significant change in readmission rates.…”