Hospital Pharmacy - June 2017 - 442

442

Hospital Pharmacy 52(6)

Table 3. Logistic Regression Model Using 30-Day All-Cause ED
Returns as the Outcome Variable and All Variable With Bivariate
Significance as Predictors.

THM vs SPP
Male gender
Ethnicity
Caucasian
Hispanic
Native American
African American
Insurance
Private
Self-pay
Public
Institutional
Reason for initial visit
Pain
Respiratory
Skin/wound care
Urinary tract infection

Adjusted odds

95% CI

1.7
1.6

1.1-2.6
1.1-2.5

.01
.03

Ref
1.0
1.2
3.0

0.6-1.7
0.6-2.7
1.2-7.4

NS
NS
.02

Ref
2.2
3.3
5.1

0.9-5.4
1.3-8.3
2.0-13.0

NS
.01
<.01

Ref
0.4
0.9
1.2

P value

receiving SPP. We identified specific variables that help predict the reason for these returns.
As CMS places increasing emphasis on preventable readmissions or "bounce-backs," strategies for improving the quality of discharge care, such as the use of THMs, will continue to
be of wide interest throughout the medical community.19 The
results of this study suggest that further research is needed in
the area of utilizing THMs to reduce repeat ED visits.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
0.1-1.5
0.3-3.3
0.3-4.7

NS
NS
NS

Note. CI = confidence interval; THM = Take Home Medication;
SPP = standard paper prescription; NS = nonsignificant.

7-day return and found the same trend toward increased ED
returns by the THM group (10% vs 6%, P = .6) still present.
It is possible that the distinct follow-up duration as well as
medications and conditions included underlie the divergent
results.

Limitations
This study had several limitations. The research was conducted within a single university health system, and it is
unknown whether patients presented to other EDs within the
30-day window. Furthermore, it is unknown whether
patients in the SPP group filled their prescriptions and
whether patients in either group completed the full course of
medications.
In addition, as noted above the decision to provide a THM
is at the discretion of the treating provider. Because THMs
have been an integral part of practice in our ED for many
years, it was not possible to conduct a prospective randomized controlled trial or to examine rates of return before and
after introduction of this resource. Furthermore, as this was
an observational study, the results reflect association but do
not indicate causation.

Conclusions
Within this study population, patients receiving THMs
demonstrated a higher all-cause return rate than patients

1. Thomas EJ, Burstin HR, O'Neil AC, Orav EJ, Brennan TA.
Patient noncompliance with medical advice after the emergency department visit. Ann Emerg Med. 1996;27(1):49-55.
2. Gadkari AS, McHorney CA. Medication nonfulfillment rates
and reasons: narrative systematic review. Curr Med Res Opin.
2010;26(3):683-705.
3. James TD, Smith PC, Brice JH. Self-reported discharge
instruction adherence among different racial groups seen in the
emergency department. J Natl Med Assoc. 2010;102(10):931936.
4. Olshaker JS, Barish RA, Naradzay JF, Jerrard DA, Safir
E, Campbell L. Prescription noncompliance: contribution to emergency department visits and cost. J Emerg Med.
1999;17(5):909-912.
5. Ginde AA, Von Harz BC, Turnbow D, Lewis LM. The effect
of ED prescription dispensing on patient compliance. Am J
Emerg Med. 2003;21(4):313-315.
6. Hohl CM, Abu-Laban RB, Brubacher JR, et al. Adherence
to emergency department discharge prescriptions. CJEM.
2009;11(2):131-138.
7. Saunders CE. Patient compliance in filling prescriptions after
discharge from the emergency department. Am J Emerg Med.
1987;5(4):283-286.
8. Freeman CP, Guly HR. Do accident and emergency patients
collect their prescribed medication? Arch Emerg Med.
1985;2(1):41-43.
9. Matsui D, Joubert GI, Dykxhoorn S, Rieder MJ. Compliance
with prescription filling in the pediatric emergency department.
Arch Pediatr Adolesc Med. 2000;154(2):195-198.
10. Kajioka EH, Itoman EM, Li ML, Taira DA, Li GG, Yamamoto
LG. Pediatric prescription pick-up rates after ED visits. Am J
Emerg Med. 2005;23(4):454-458.
11. Beardon PH, McGilchrist MM, McKendrick AD, McDevitt
DG, MacDonald TM. Primary non-compliance with prescribed
medication in primary care. BMJ. 1993;307(6908):846-848.
12. Fischer MA, Stedman MR, Lii J, et al. Primary medication
non-adherence: analysis of 195,930 electronic prescriptions. J
Gen Intern Med. 2010;25(4):284-290.



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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