Hospital Based Medication Delivery

Hospital readmission is a costly and common occurrence in the United States. Research suggests that a portion of all hospital readmissions can be attributed to medication non-adherence after discharge. One strategy for improving adherence to prescribed medications is to ensure patients obtain medications as prescribed before they leave the hospital. A program called Med-READI was developed at a large teaching hospital in the Salt Lake Valley to remove barriers in obtaining medications and improve post-discharge medication adherence. The utilization and effectiveness of this program had not been well-evaluated, specifically in regards to those who opted to not use the program (non-utilizers). The specific objectives of this scholarly project were as follows (1) identify differences between patients who both chose and chose not to utilize a hospital based medication delivery program; (2) determine if commonalities exist for not utilizing the program; (3) determine medication adherence rates for program non-utilizers; and (4) disseminate findings to key stakeholders in pharmacy services. A thorough literature review demonstrated the complexity and multivariate nature of hospital readmission. Many barriers prevent or deter patients from obtaining their prescribed medications; however, by focusing on medication adherence, this project addressed one factor known to contribute to hospital readmission. This project sought to analyze utilization trends of a pre-discharge medication delivery program to address quality improvement opportunities. To further evaluate the effectiveness of this program this project analyzed whether non-utilizers had filled their discharge medications within twenty-four hours post-discharge. In order to determine utilization trends, data were collected and analyzed over two weeks. Those who utilized the Med-READI program were compared to those who did not utilize the Med-READI program in terms of gender, age, insurance coverage, and rural or urban home location. Insurance-based differences were notable when this trend analysis was performed. Patients' reasons for opting out of the Med-READI program were also compiled, and a hierarchy of reasons why the program was not utilized was developed. Lastly, the medication adherence rates of non-utilizers were determined by a phone survey of patients who opted out of the program and assessed for post-discharge medication obtainment. The results of this survey indicated a high rate of non-adherence for those who opted out. This information was then presented to stakeholders in pharmacy services to allow for quality improvement of the Med-READI program and to better understand its effectiveness. This information was also disseminated through a poster presentation at the University of Utah College of Nursing Medication adherence is a known contributor to hospital readmission. Programs have been developed to alleviate the concern for poor medication adherence post-discharge. The proposed project allowed for a better understanding of the utilization and effectiveness of one such program called Med-READI. Quality improvement of the Med-READI program will allow for increased patient participation and potential reduction in hospital readmission.