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Readmissions Reduced When Patients Sent Home with Medications

BOSTON – When patients hospitalized for asthma exacerbations fail to fill discharge prescriptions, hospitals often see them again, either as emergency department patients or readmissions.

The challenge taken on by a research team from Boston University and Boston Medical Center was to increase the proportion of patients discharged from an asthma admission in possession of their medications – i.e., “meds in hand” -- from a baseline of 0% to greater than 75%.

For the report published recently in Pediatrics, study authors conducted an exploratory, retrospective analysis of insurance data with a sample of Medicaid-insured patients. Post-discharge medication adherence between patients discharged with meds in hand and usual care were compared.

Among the changes to the discharge process was a service whereby outpatient pharmacists delivered medications to patient rooms. That immediately met the goal of 75% of patients leaving the hospital with meds in hand.

In a subset of patients for whom all insurance claims were available, researchers found that those discharged with meds in hand had lower odds of all-cause re-presentation to the ED within 30 days of discharge, compared with patients discharged with usual care.

“Our initiative led to several discharge process improvements, including the creation of a medication delivery service that increased the proportion of patients discharged in possession of their medications and may have decreased unplanned visits after discharge,” the authors point out.

Another study last year found that the number of discharge medications is associated with the prevalence of 30-day hospital readmission.

Writing in BMC Health Services Research, a Washington University-led study team reported that a risk score including the number of discharge medications can accurately predict patients at risk of readmission.

“Our findings suggest that relatively simple and accessible parameters can identify patients at high risk for hospital readmission potentially distinguishing such individuals for interventions to minimize readmissions,” study authors wrote.