Emergency department medication dispensing reduces return visits and admissions

Blome, Andrea; Kaigh, Caroline; Shaffer, Claire; Peoples, Emily; Satz, Wayne A.; Kim, Eun; Baby, George; Stauffer, Karen; Schreyer, Kraftin E.

doi:10.1016/j.ajem.2020.08.082

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…In contrast, providing antibiotics for skin and soft tissue infections through an emergency department has demonstrated a cost savings through decreased emergency department utilization. 41 Our findings suggest several areas for future research. Investigation of the provider role in medication provision may elucidate the varying impact of clinician guidance on later adherence and readmission.…”

Section: Discussionmentioning

confidence: 78%

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

Stedge¹,

Kubes³

et al. 2023

Southern Medical Journal

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Objectives: Medication nonadherence caused by difficulty obtaining and paying for medicines can increase hospital readmissions. This project implemented Medications to Beds ("Meds to Beds," M2B), a multidisciplinary predischarge medication delivery program, at a large urban academic hospital that provided subsidized medications for uninsured and underinsured patients to reduce readmissions.Methods: This 1-year retrospective analysis of patients discharged from the hospitalist service after implementing M2B contained two groups: one with subsidized medications (M2B-S) and one with unsubsidized medications (M2B-U). Primary analysis was 30-day readmission rates for patients, stratified by Charlson Comorbidity indexes (CCIs) of 0, 1-3, ≥4 to represent low, medium, and high comorbidity burden. Secondary analysis included readmission rates by Medicare Hospital Readmission Reduction Program diagnoses.Results: Compared with controls, the M2B-S and M2B-U programs had significantly reduced readmission rates among patients with CCIs of 0 (10.5% [controls] vs 9.4% [M2B-U] and 5.1% [M2B-S], P < 0.05). A nonsignificant reduction occurred in readmissions for patients with CCIs ≥4 (20.4% [controls] vs 19.4% [M2B-U] vs 14.7% [M2B-S], P < 0.07). Patients with CCIs of 1 to 3 showed a significant increase in readmission rates in the M2B-U, but a decrease in readmission rates among the M2B-S (15.4% [controls] vs 20% [M2B-U] vs 13.1% [M2B-S], P < 0.05). Secondary analyses found no significant differences in readmission rates when patients were stratified by Medicare Hospital Readmission Reduction Program diagnosis. Cost analyses demonstrated that subsidizing medicines cost less per patient for every 1% readmission reduction than delivery alone.Conclusions: Providing medicine to patients predischarge tends to lower readmission rates for populations with no comorbidities or with a high burden of disease. This effect is amplified when prescription costs are subsidized.

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Section: Discussionmentioning

confidence: 78%

“…The price, however, does not account for transportation to a pharmacy. In contrast, providing antibiotics for skin and soft tissue infections through an emergency department has demonstrated a cost savings through decreased emergency department utilization 41 …”

Section: Discussionmentioning

confidence: 99%

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

Stedge¹,

Kubes³

et al. 2023

Southern Medical Journal

View full text Add to dashboard Cite

show abstract

“…6 Other studies have shown the benefit of "med to bed" or "take-home" programs to facilitate medication compliance when there is concern about a patient's access, such as in anticoagulants and medications for opioid use disorder. [49][50][51] Though other ED "take-home" medications may be charged to a patient's healthcare insurance plan, this mechanism is not currently possible for EPT, as most health insurers will not pay for medication for anyone other than the covered individual. One known exception is California, where, since February 2020, the state Medicaid provider -including Medi-Cal and Family PACT insurance -must cover partner EPT medications for low-income patients.…”

Section: Discussionmentioning

confidence: 99%

Mixed-method evaluation of an expedited partner therapy take-home medication program: a pilot ED intervention to improve sexual health equity

Ager

Sturdavant

Curry

et al. 2023

Preprint

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Background: Treatment for partners of patients diagnosed with sexually transmitted infections (STIs), referred to as expedited partner therapy (EPT), is infrequently used in emergency departments (EDs). This was a pilot program to initiate and evaluate EPT through medication-in-hand ('take-home') kits or paper prescriptions. This study aimed to assess the frequency of EPT prescribing, the efficacy of a randomized best practice advisory (BPA) on the uptake of EPT, perceptions of ED clinicians regarding the EPT pilot, and factors associated with EPT prescribing. Methods: This pilot study was conducted at an academic ED in the midwestern US between August and October 2021. The primary outcome was EPT prescription uptake and the BPA impact was measured via chart abstraction and analyzed through summary statistics and Fishers exact test. The secondary outcome of barriers and facilitators to program implementation was analyzed through ED staff interviews (physicians, physician assistants, and nurses). A rapid qualitative assessment method for the analysis of the interviews was employed. Results: Fifty-two ED patients were treated for chlamydia/gonorrhea during the study period. EPT was offered to 25% (95% CI 15%-39%) of patients. EPT was prescribed twice as often (85% vs. 38%; p<0.01) when the interruptive pop-up alert BPA was shown. Barriers identified in the interviews included workflow constraints and knowledge of EPT availability. The BPA was viewed positively by the majority of participants. Conclusions: In this pilot EPT program, EPT was provided to 25% of ED patients who appeared eligible to receive it. The interruptive pop-up alert BPA significantly increased EPT prescribing. Barriers identified to EPT prescribing can be the subject of future interventions to improve ED EPT provision.

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“…Western Journal of Emergency Medicine 1001 access, such as in anticoagulants and medications for opioid use disorder. [49][50][51] Although other ED "take-home" medications may be charged to a patient's healthcare insurance plan, this mechanism is not currently possible for EPT, as most health insurers will not pay for medication for anyone other than the covered individual. One known exception is California, where, since February 2020, the state Medicaid providerincluding Medi-Cal and Family PACT insurancemust cover partner EPT medications for low-income patients.…”

Section: Discussionmentioning

confidence: 99%

Mixed-methods Evaluation of an Expedited Partner Therapy Take-home Medication Program: Pilot Emergency Department Intervention to Improve Sexual Health Equity

Ager,

Sturdavant,

Curry

et al. 2023

WestJEM

View full text Add to dashboard Cite

Background Treatment for partners of patients diagnosed with sexually transmitted infections (STI), referred to as expedited partner therapy (EPT), is infrequently used in the emergency department (ED). This was a pilot program to initiate and evaluate EPT through medication-in-hand (“take-home”) kits or paper prescriptions. In this study we aimed to assess the frequency of EPT prescribing, the efficacy of a randomized best practice advisory (BPA) on the uptake, perceptions of emergency clinicians regarding the EPT pilot, and factors associated with EPT prescribing. Methods We conducted this pilot study at an academic ED in the midwestern US between August–October 2021. The primary outcome of EPT prescription uptake and the BPA impact was measured via chart abstraction and analyzed through summary statistics and the Fisher exact test. We analyzed the secondary outcome of barriers and facilitators to program implementation through ED staff interviews (physicians, physician assistants, and nurses). We used a rapid qualitative assessment method for the analysis of the interviews. Results During the study period, 52 ED patients were treated for chlamydia/gonorrhea, and EPT was offered to 25% (95% CI 15%–39%) of them. Expedited partner therapy was prescribed significantly more often (42% vs 8%; P < 0.01) when the interruptive pop-up alert BPA was shown compared to not shown. Barriers identified in the interviews included workflow constraints and knowledge of EPT availability. The BPA was viewed positively by the majority of participants. Conclusion In this pilot EPT program, expedited partner therapy was provided to 25% of ED patients who appeared eligible to receive it. The interruptive pop-up alert BPA significantly increased EPT prescribing. Barriers identified to EPT prescribing should be the subject of future interventions to improve provision of EPT from the emergency department.

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Emergency department medication dispensing reduces return visits and admissions

Cited by 9 publications

References 14 publications

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

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

Mixed-method evaluation of an expedited partner therapy take-home medication program: a pilot ED intervention to improve sexual health equity

Mixed-methods Evaluation of an Expedited Partner Therapy Take-home Medication Program: Pilot Emergency Department Intervention to Improve Sexual Health Equity

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