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Gender trended toward significance (P = .067) and was also
included in the multiple variable model. The logistic regression model compared all-cause return to the ED as the outcome variable to these significant demographic variables and
the study group (THM vs SPP) as independent variables. A
number of independent predictors of all-cause ED returns
were identified. Variables associated with increased odds of
returning to the ED within 30 days included study group
(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). Table 3 lists the results
of the logistic model and 95% CIs. The Hosmer-Lemeshow
statistic was 0.8 indicating good fit to the model.
Discussion
Figure 1. Patient Flow.
in demographic characteristics or the reason for medication;
however, there were significant differences in the medication
prescribed. Compared with the SPP group, individuals in the
THM group were more likely to receive antibiotics (66% vs
49%), methocarbamol (9% vs 5%), and albuterol (12% vs
4%) but were less likely to receive ibuprofen (15% vs 34%).
These results can be seen in Table 2.
Analysis of 30-Day Returns
No significant difference was found between the THM and
SPP groups with respect to non-ED provider visits in the university system. Among THM patients, 81 (30%) saw a nonED provider within 30 days. Within the SPP group, 165
patients (37%) had a recorded visit with a non-ED provider.
In the bivariate analysis, there was a significant difference
between patients receiving THMs (53/268, 20%) versus
those receiving SPPs (56/443, 13%) in all-cause 30-day
returns to the ED (difference = 7%, 95% confidence interval
[CI], 0%-15%). For cause-specific 30-day returns, there was
no significant difference comparing THM (33/268, 12%) to
SPP (35/443, 8%) groups (difference = 4%, 95% CI, -2 to
11). There were multiple reasons for the return ED visits.
Approximately 3/4 of the cases were pain related (28%),
respiratory complaints (14%), urinary tract infection (14%),
and skin/wound care (17%). Other diagnostic categories
each represented less than 5% of the cases. For consideration
in the multivariable analysis, the variable was reduced to one
of these 4 diagnostic groups or other.
A bivariate analysis comparing 30-day all-cause returns
to the study group, all demographic variables, and medication variables was only significant for the study group (THM
vs SPP, P = .01), ethnicity (P < .01), and insurance (P < .01).
Our study showed that patients given THMs were more
likely to return to the ED within 30 days but often for a problem unrelated to the initial complaint. These study findings
contradict the initial hypothesis that patients receiving THMs
would be less likely to return to the ED within 30 days. The
trend for cause-specific ED returns was in the same direction
as the all-cause returns suggesting that had our sample size
been larger we may have found the same results for this
group.
There are several potential explanations for these results.
It is possible that providers preferentially give THMs to
patients with fewer resources, who are more likely to use the
ED as a usual source of care. This would be consistent with
the finding that the THM group had a higher rate of return
visits for all-causes but did not demonstrate significantly
increased return rate for the index visit complaint. Along
similar lines, it may be that without the availability of THMs,
the group receiving these medications would have had significantly higher rates of return. In other words, THMs may
equalize patients who face increased barriers to access with
those who have adequate ability to access discharge prescriptions as outpatients.
Another possibility is that THMs enhance patient satisfaction, increasing the likelihood of using the ED as a preferred
source of care. For patients with barriers to follow-up, such
as lack of transportation and limited financial resources, it is
likely more convenient to receive both medical care and the
necessary THM together in a single location as compared
with adding a visit to the pharmacy, as would be the case if
receiving treatment in most outpatient clinic settings. Of
note, our institution does not have an outpatient pharmacy
physically located in the hospital, which could be a barrier to
patients filling a SPP.
There are few previous studies examining THMs. One
study by Strang et al found that patients given education and
a home naloxone supply were able to successfully use naloxone to reverse opiate overdose. Another study describing the
use of medication kits for symptomatic emergencies found
86% of home hospice services reported the kits averted
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2017
Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
ISMP Medication Error Report Analysis
Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Formulary Drug Reviews: Plecanatide
Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Financial Effect of a Drug Distribution Model Change on a Health System
Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 381
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Hospital Pharmacy - June 2017 - 387
Hospital Pharmacy - June 2017 - Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
Hospital Pharmacy - June 2017 - 389
Hospital Pharmacy - June 2017 - ISMP Medication Error Report Analysis
Hospital Pharmacy - June 2017 - 391
Hospital Pharmacy - June 2017 - 392
Hospital Pharmacy - June 2017 - 393
Hospital Pharmacy - June 2017 - Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Hospital Pharmacy - June 2017 - 395
Hospital Pharmacy - June 2017 - 396
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Hospital Pharmacy - June 2017 - Formulary Drug Reviews: Plecanatide
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Hospital Pharmacy - June 2017 - 404
Hospital Pharmacy - June 2017 - 405
Hospital Pharmacy - June 2017 - Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - June 2017 - 407
Hospital Pharmacy - June 2017 - Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Hospital Pharmacy - June 2017 - 409
Hospital Pharmacy - June 2017 - 410
Hospital Pharmacy - June 2017 - 411
Hospital Pharmacy - June 2017 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
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Hospital Pharmacy - June 2017 - Financial Effect of a Drug Distribution Model Change on a Health System
Hospital Pharmacy - June 2017 - 423
Hospital Pharmacy - June 2017 - 424
Hospital Pharmacy - June 2017 - 425
Hospital Pharmacy - June 2017 - 426
Hospital Pharmacy - June 2017 - 427
Hospital Pharmacy - June 2017 - Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Hospital Pharmacy - June 2017 - 429
Hospital Pharmacy - June 2017 - 430
Hospital Pharmacy - June 2017 - 431
Hospital Pharmacy - June 2017 - 432
Hospital Pharmacy - June 2017 - Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Hospital Pharmacy - June 2017 - 434
Hospital Pharmacy - June 2017 - 435
Hospital Pharmacy - June 2017 - 436
Hospital Pharmacy - June 2017 - 437
Hospital Pharmacy - June 2017 - Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
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