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Sarangarm et al
Table 1. Available Take Home Medications (THM).
Albuterol inhaler 90 µg THM-Inhale 1 to 2 puffs by mouth every 4 hours as needed
for shortness of breath
Amoxicillin 500 mg #30 THM-Take 1 capsule by mouth every 8 hours until all
taken
Azithromycin 250 mg #6 THM-Take 2 tables by mouth today, then take 1 tablet
every day for 4 days
Bactrim DS #20 THM-Take 1 tablet by mouth every 12 hours until all taken
Beclomethasone 40 µg THM-Inhale __ puffs by mouth twice a day
Cephalexin 500 mg #40 THM-Take 1 capsule by mouth every 6 hours for 10 days
Ciprofloxacin 250 mg #6 THM-Take 1 tablet by mouth 2 times a day for 3 days
Ciprofloxacin 500 mg #14 THM-Take 1 tablet by mouth 2 times a day as directed
Clindamycin 150 mg #56 THM-Take __ capsule(s) by mouth every __ hour(s) as
directed
Clonidine 0.1 mg #25 THM-Take 1 tablet by mouth 4 times a day for 3 days, 3
times a day for 2 days, twice daily for 2 days, then 1 daily
Diphenhydramine 25 mg #20 THM-Take 1 tablet by mouth every 6 to 8 hours as
needed for itching, anxiety, insomnia
Doxycycline 100 mg #20 THM-Take 1 capsule by mouth every 12 hours for 10
days
Ibuprofen 600 mg #10 THM-Take 1 tablet by mouth every 6 to 8 hours as directed
Methocarbamol 750 mg #28 THM-Take 1 tablet by mouth 4 times a day or as
directed
Moxifloxacin 400 mg #7 THM-Take 1 tablet by mouth every day for 7 days
Nitrofurantoin 100 mg #28-Take 1 capsule by mouth 4 times daily for 7 days
Penicillin VK 500 mg #40 THM -Take __tablet(s) by mouth every __ hours. Take
until all finished.
Phenytoin 100 mg #21 THM-Take 1 capsule by mouth 3 times a day as directed
Prednisone 10 mg #30 THM-Take __ tablet(s) by mouth every __ hour(s) as
directed
Promethazine 25 mg #6 THM-Take 1 tablet by mouth every 8 hours as needed for
nausea

receiving THMs would be less likely to return to the ED
within 30 days of the index visit.

Methods
Study Design and Setting
This was an observational, prospective cohort study. The study
site is an academic ED in an urban, university hospital with a
census of approximately 90 000 adult patients per year. All
adults evaluated in the ED were eligible for study inclusion.
THMs have been available in this institution for approximately
10 years and are accepted as an established component of ED
practice, but the effects of this resource have not previously
been formally evaluated. THM are prepackaged by pharmacy
and are available in automated dispensing cabinets in the ED.
Available THMs range from an albuterol inhaler to a full course
of antibiotics (Table 1). Institutional guidelines state that THMs
are intended for patients enrolled in the county-funded institutional financial assistance program and are to be given to
patients discharged outside of outpatient pharmacy hours.
However, in practice the decision to prescribe a THM is at the
discretion of individual providers. In this study, we compared
patients receiving THMs with the patients receiving SPPs.

Selection of Participants
Consecutive adult patients discharged from the ED with
either a THM or an equivalent SPP from August 26, 2012, to

September 22, 2012, were considered for inclusion. Patients
were excluded if they were younger than 18 years, received
a combination of THMs and SPPs, were admitted to the hospital, or were discharged to a location other than home. In
addition, patients were excluded from analysis if they
returned to the ED after being instructed to do so upon discharge from the index visit, such as for a wound recheck.
Inclusion was not contingent on presenting complaint or discharge diagnosis.

Methods and Measurements
ED patients discharged with a THM or equivalent SPP during the study period were prospectively identified through
daily pharmacy reports. For each patient, baseline characteristics including age, gender, identification of a 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 any repeat visits were
complaint-specific, that is, the same complaint targeted by
the THM or SPP from the index visit. We also recorded
whether patients saw another provider in the university
health care system, such as a primary care clinic or urgent
care, within 30 days. The study was IRB approved.

Data Analysis
Patient demographic characteristics and types of medications
prescribed were compared between the study groups using
the appropriate bivariate analysis (t test for continuous and
chi-square for categorical variables, respectively).
The all-cause 30-day return rate was the primary outcome
variable. All variables were examined for bivariate significance in relation to this outcome variable. Significant variables were included in the model. Multiple logistic regression
was used to compare the odds of a 30-day ED visit between
the study groups after controlling for potential confounders.
Hosmer-Lemeshow statistic was used to determine goodness
of fit.
Data analysis was performed using SPSS 21 (IBM,
Armonk, New York). A power analysis was performed
assuming equal sized groups and a normal return rate to the
ED of 25% based on previous experience. We found 80%
power to show a decrease of 10% in return rates using 250
patients per group or 500 total patients.

Results
Characteristics of Study Subjects
Pharmacy reports identified 826 eligible patients, of whom
115 were excluded (Figure 1). The most common reason for
exclusion was planned repeat ED visit (34.8%). Among the
711 subjects included, 268 received a THM and 443 received
a SPP. No significant differences were found between groups

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