Mount Sinai Hospital implemented a medication program to improve patient medication adherence.
Collaborator (Non-Members)Zahra Khudeira, PharmD, BCPS; Matthew Dandino, PharmD
Tamblyn and colleagues found that nearly a third of patients fail to fill first-time prescriptions.1 Other studies have found that e-prescriptions are 65% more likely to be left abandoned at a retail pharmacy by patients than hand-written prescriptions. 3 Mount Sinai Hospital (MSH) recognizes that the issue of medication adherence is challenging. MSH strives to become the national model for the delivery of urban healthcare and develops innovative and effective ways to accomplish its mission.
In the communities served by MSH, the percentage of citizens living below the poverty line ranges from 14% to 45%. Ten of the 13 communities MSH serves have a poverty rate higher than the Chicago average of 22%. Three communities (East Garfield Park, North Lawndale, and West Garfield Park) have a poverty rate two times higher than the city average.
The literacy rate for MSH’s community served is another barrier to medication adherence. Nineteen percent of Chicago adults over age 25 do not have a high school diploma. In 12 of the 13 communities, the percentage of adults without a high school diploma is higher than the city average. In two communities (Gage Park and South Lawndale), over half of adults lack a high school diploma.
Another limitation of MSH’s patient population is the lack of transportation. Patients depend on family members, neighbors and friends to commute. Financial concerns and long wait times are other barriers that patients voice as concerns for filling outpatient medications.
What We Tried
Due to all of the above challenges, the pharmacy leadership team implemented a “discharge technician” role in March 2013, staffed one to three times per week, based on departmental availability. This technician’s role had two main responsibilities:
- Communicate with the decentralized pharmacists regarding planned discharges.
- Assist in filling the discharge prescriptions at our onsite retail pharmacy to ensure the patient obtains all medications prior to discharge.
The discharge technician position quickly transformed into a full time role due to the value of ensuring patients leave with their medications in hand. MSH now has a dedicated technician working full-time on the weekdays. On weekends, pharmacists cover on an as needed basis. This technician has been able to significantly increase the number of patients that have received their “meds to bed” prior to discharge.
This discharge prescription program has been very successful. The amount of prescriptions filled and patients counseled before discharge has steadily increased.
There are three main barriers to the discharge program. First, one technician cannot service the entire hospital’s discharge patients. The MSH decentralized pharmacists routinely prioritize complex patients (COPD, DM, HF, etc.). This prioritization has resulted in a concentrated focus on patients likely to be re-admitted.
Second, the outpatient pharmacy hours are shortened on the weekend, thus reducing numbers of prescriptions filled on the weekend.
Third, the current timing of obtaining the filled discharge prescriptions and discharging the patient from the nursing unit are not aligned resulting in some patients waiting in the outpatient area to obtain their prescriptions.
- Make a decision to pilot the program, even if it is on only one unit. Strategize to choose the best unit to grow revenue for the hospital
- Choose a technician with outpatient experience that has a solid knowledge base of insurance plans and prior authorizations
- Track the number of medications filled and patients affected, in order to monitor progress of program
- Document significant catches made by the discharge technician
- Report data with good catches to the Medical Executive team
- Track total discharges to obtain the number of patients that benefit from the program
- Consider a patient survey to ascertain patient satisfaction with the program
- Communicate with house staff to ensure program support
- Communicate the value of the program to patients
- Target high-risk patients for post discharge phone calls
The “Meds to Bed Program” has positively impacted patients, who are grateful for this service. This program can improve medication adherence, outpatient pharmacy revenue, reduce avoidable readmissions and enhance patient satisfaction. The objectives of this program should be shared with the hospital staff to ensure success. Other institutions should consider offering this service to ensure medication access and to reduce patient readmissions.
- Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med.2014 Apr 1;160(7):441-50.
- Shin J , McCombs JS , Sanchez RJ , Udall M , Deminski MC , Cheetham TC. Primary nonadherence to medications in an integrated healthcare setting. Am J Manag Care. 2012; 18(8):426-34.