Hospital Pharmacy - June 2017 - 438

717396
research-article2017

HPXXXX10.1177/0018578717717396Hospital PharmacySarangarm et al

Article

Patients Given Take Home Medications
Instead of Paper Prescriptions Are
More Likely to Return to Emergency
Department

Hospital Pharmacy
2017, Vol. 52(6) 438-443
© The Author(s) 2017
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https://doi.org/10.1177/0018578717717396
DOI: 10.1177/0018578717717396
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Dusadee Sarangarm1, Preeyaporn Sarangarm2,
Melissa Fleegler1, Amy Ernst1, and Steven Weiss1

Abstract
Objective: The aim of this study was to compare the 30-day emergency department (ED) return rate between patients
given a Take Home Medication pack (THM) versus a standard paper prescription (SPP) prior to discharge. Methods: This
was an observational, prospective cohort study in an urban, university-affiliated, level I trauma center. Patients were identified
through daily pharmacy reports. Consecutive adult patients discharged from the ED with either a THM or equivalent SPP
were included. For each patient, baseline characteristics including age, gender, primary care provider (PCP), primary language,
ethnicity, marital status, and insurance status were recorded from the electronic medical record (EMR). Review of the EMR
was used to determine whether patients returned to the ED within 30 days and whether the return visit was for all-causes
or for the same complaint targeted by the THM or SPP from the index visit. Similarly, visits to other providers in the health
system within 30 days were recorded. Results: A total of 711 patients were included in the study, with 268 receiving a
THM and 443 receiving a SPP. In comparison with the SPP group, the THM group was more likely to have an all-cause
return (Relative Risk [RR] = 1.7, P < .01). Variables associated with increased odds of returning to the ED within 30 days
included study group (adjusted Odds Ratio [aOR]: 1.7), male gender (aOR: 1.6), African American ethnicity (aOR: 3.0),
public insurance (aOR: 3.3), and institutional financial assistance (aOR: 5.0). The difference between study groups for index
visit complaint-specific returns was not significant. Conclusions: Patients receiving a THM demonstrated a higher all-cause
return rate than patients receiving a SPP. A randomized study is needed evaluating the effect of THM on return ED visits.
Keywords
readmissions, patient discharge, prescriptions, health care utilization

Introduction
Background and Importance
Medication nonadherence following emergency department
(ED) discharge is associated with recurrent ED visits, leading
to increased costs to the health care system.1-4 Such repeat visits have recently gained greater attention given the potential
associated financial ramifications of the Centers for Medicare
and Medicaid Services (CMS) Hospital Readmissions
Reduction Program. Several studies have found low rates of
medication adherence following discharge from the ED, and it
has been reported that as many as 4 in 10 ED patients do not
take discharge medications as prescribed.5-10 Nonadherence to
medications has been reported to be as high as 22.5% and even
higher for new prescriptions at 28.3%.11,12
One potential strategy to address medication nonadherence is to provide patients with Take Home Medication
packs (THM) prior to ED discharge. A THM is a packaged

full course of a prescribed medication that can be given to a
patient in place of a standard paper prescription (SPP),
thereby eliminating the need for the patient to go to a pharmacy. However, there are few studies examining such
interventions.5,13-15

Goals of This Investigation
The aim of the study was to compare rate of returns to the ED
between patients given a THM prior to discharge and patients
receiving an equivalent SPP. We hypothesized that patients
1

The University of New Mexico, Albuquerque, USA
University of New Mexico Hospital, Albuquerque, USA

2

Corresponding Author:
Preeyaporn Sarangarm, Department of Pharmacy, University of New
Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
Email: psarangarm@salud.unm.edu
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