Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital

Abstract

The World Health Organization 2003 report on medication adherence 1 quoted Haynes that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." An obvious, yet critical, component to medication adherence is access to medications; consequently the failure either to fill new prescriptions or to refill existing ones is a critical point of failure in the postdischarge care of patients. 1, 2 Previous work at our institution has demonstrated a sustained reduction in hospital and emergency department (ED) reutilization in part due to efforts abstract OBJECTIVES: In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS:A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS:During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS: Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.

An Iterative Quality Improvement Process Improves Pediatric Ward Discharge Efficiency

“…There is limited evidence for effectiveness of specific interventions to improve pediatric discharge efficiency. Many interventions have been studied in limited contexts, such as implementation of a discharge risk assessment, 10 a "medications-in-hand" policy on hospital discharge, 11 or a ward discharge coordinator to schedule outpatient follow-up. In several studies, researchers have shown that quality improvement (QI) methods can leverage existing resources and account for local needs to improve discharge efficiency without compromising care quality or family satisfaction.…”

Factors Associated With Return Visits at 7 Days After Hospital Discharge

“…4,17 Although a relationship between medications and risk of return visits has been previously described, we did not evaluate medication use at discharge. 18 Lastly, we did not have information regarding adherence to evidence-based practices during transition from the ED to inpatient units, all of which have been identified as factors that may influence readmissions. [19][20][21][22][23][24]…”

Multidisciplinary Engagement Increases Medications in-Hand for Patients Hospitalized With Asthma

“…4 In addition, patients discharged with their asthma medications in-hand have been shown to have a decreased risk of emergency department visits in single centers. 6,7 In these studies, researchers have highlighted important system changes to increase medication possession at the time of discharge, for example, focusing on establishing a discharge medication delivery service 6 or establishing partnerships with community pharmacies. 7 However, to the best of our knowledge, our project is the first to report on a specific strategy, the multidisciplinary huddle, to overcome identified barriers in facilitating medications in-hand at discharge and establish clear closed-loop communication for discharge planning.…”

“…5 Recently, a few hospital systems have focused on increasing medication access by ensuring that patients are discharged from their inpatient encounter with their asthma medications in their possession. [6][7][8][9] In these single-center efforts, increasing medications inhand at discharge has been shown to increase patient satisfaction and decrease health care reuse. 6,7,10 Our institution, the Children's National Medical Center, admits ∼1400 children with asthma annually, which is ∼10% of annual admissions to the hospital.…”

“…[6][7][8][9] In these single-center efforts, increasing medications inhand at discharge has been shown to increase patient satisfaction and decrease health care reuse. 6,7,10 Our institution, the Children's National Medical Center, admits ∼1400 children with asthma annually, which is ∼10% of annual admissions to the hospital. This is likely related to the increased prevalence of asthma in Washington, DC, which approaches 14%, compared with the national prevalence of pediatric asthma, which has been reported to be 8.3%.…”