Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project

Abstract

Asthma is the second most costly chronic disease in children. 1 Emergency department (ED) visits, admissions, and readmissions account for the most expensive components of care. Ensuring patient possession of medications at discharge from hospitalization is a recognized strategy to reduce unplanned presentations to care. [2][3][4] Although medication possession does not guarantee adherence to a treatment plan, it eliminates the posthospitalization burden of going to a pharmacy, makes certain families have cleared all insurance barriers, and allows medicationrelated questions to be answered with the product in hand. However, routine disbursement of outpatient medications before discharge is not standard care for most pediatric abstract BACKGROUND AND OBJECTIVES: Many patients recently discharged from an asthma admission do not fill discharge prescriptions. If unable to adhere to a discharge plan, patients with asthma are at risk for re-presentation to care. We sought to increase the proportion of patients discharged from an asthma admission in possession of their medications (meds in hand) from a baseline of 0% to >75%.

Discharge medication procurement and education after kidney transplantation

“…Over one-third of kidney graft losses are associated with medication nonadherence, and the odds of graft failure increase 7-fold in nonadherent compared with adherent patients. 1 It is estimated that kidney transplant patients take on average 8 medications per day, which can equate to [15][16][17][18][19][20] were to describe discharge medication procurement practices, discharge medication teaching practices, and attitudes toward the value of medication education. A total of 155 responses were received from 115 different transplant centers.…”

“…14 On the other hand, providing asthma medications to patients prior to discharge resulted in a 78% reduction in the odds of re-presentation at the emergency department, suggesting that "meds-to-beds" programs may help enhance adherence, reduce readmission, and prevent adverse medical events. 15 Although no transplant-specific data exist to our knowledge, there is no evidence to suggest that transplant recipients would be at a reduced risk of these adverse events, given the high cost and medical complexity of transplantation.…”

Implementation and Sustainability of a Pharmacy-Led, Hospital-Wide Bedside Medication Delivery Program: A Qualitative Process Evaluation Using RE-AIM

“…Bedside medication delivery programs, commonly referred to as "meds to beds" or "meds in hand, " involves delivering discharge medications to hospitalized patients' bedside prior to discharge and often includes a medication education component (1,2). This intervention, or program, can be provided by hospital pharmacies, on-site affiliated outpatient pharmacies, or third-party retail pharmacies.…”

Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations

“…"Meds-in-hand" mitigates medication access as a barrier to adherence by ensuring that patients are discharged from the hospital with all required medications in hand, removing any barriers to filling their initial prescriptions. 7 The Asthma Improvement Collaborative at Cincinnati Children's Hospital Medical Center (CCHMC) previously applied quality improvement methodology to implement "meds-in-hand" as a key intervention in a broad strategy that successfully reduced asthma-specific utilization for the 30-day period following an asthma-related hospitalization of publicly insured children from 12% to 7%. 8,9 At the onset of the work described in this manuscript, children hospitalized with an acute exacerbation of persistent asthma were most often treated with an ICS while inpatients in addition to a standard short course of oral systemic corticosteroids.…”