To-Go medications for decreasing ED return visits

• Published in: The American journal of emergency medicine Vol. 30; no. 9; pp. 2011 - 2014
• Main Authors: Hayes, Bryan D., PharmD, Zaharna, Leila, PharmD, Winters, Michael E., MD, Feemster, Agnes Ann, PharmD, Browne, Brian J., MD, Hirshon, Jon Mark, MD, MPH, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2012; Elsevier; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biological and medical sciences; Cellulitis - drug therapy; Codes; Cost control; Drug Costs; Drug Prescriptions; Drug stores; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Focal Infection, Dental - drug therapy; Health insurance; Hospitalization; Hospitals; Human viral diseases; Humans; Infections; Infectious diseases; Intensive care medicine; Male; Medical sciences; Medication Adherence; Patient Discharge; Prescriptions; Pyelonephritis - drug therapy; Uninsured people; Urinary Tract Infections - drug therapy; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Chemotherapy; Intensive care; Treatment; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.01.027

Abstract Objectives The primary objective was to determine if providing patients with a complete course of antibiotics for select conditions would decrease the rate of return to the emergency department (ED) within 7 days of the initial visit. Methods In an urban, academic medical center, we compared patients who received medications at discharge (To-Go medications) with patients who received standard care (a prescription at discharge). Emergency department patients were included if they were older than 18 years; had a discharge diagnosis International Classification of Diseases, Ninth Revision , code for urinary tract infection, pyelonephritis, cellulitis, or dental infection; and presented initially between January and December 2010. Candidates had limited health insurance or were discharged when nearby pharmacies were closed. Return visits were included if the condition was related to the initial diagnosis. Wound checks and scheduled revisits were excluded. Medications dispensed were penicillin, clindamycin, sulfamethoxazole-trimethoprim, and nitrofurantoin. Results A total of 4257 individuals were seen in initial ED visits for the included conditions. Comparing the 243 individuals given medications with the 4014 who were not given medications, the To-Go medications group was less likely to return than the comparison group (2.5% vs 5.9%; P = .026). The cellulitis subgroup also showed a significant reduction in return visits (1.6% vs 6.9%; P = .024). Three hundred eighteen courses of medication were given to the 243 individuals for a total cost of $1123. Conclusions For a 1-year expense of $1123, we demonstrated a 50% reduction in ED return visits for patients who were given a free, complete course of antibiotics at discharge for select conditions.