Evaluating the impact of a discharge pharmacy in the emergency department on emergency department revisits and admissions

Abstract

Importance: Medication nonadherence leads to worse health outcomes, increased healthcare service utilization, and increased overall healthcare costs.

Objective: To determine whether a discharge pharmacy located in the Emergency Department (ED) reduces ED revisits and hospitalizations.

Design: This is a cohort study where we extracted data from our electronic medical records with adult encounters between 12/2019-10/2021. For the purpose of this study, we defined a revisit to the ED as within 7 days and an admission within 30 days from prior initial ED visit.

Setting: The University of Chicago Medicine is an academic medical center located in Chicago's South Side.

Participants: Between dates of 12/2019-11/2021, we had 78,660 adult distinct encounters. We created 5 different groups: no medications prescribed, ED discharge pharmacy only, e-prescriptions to outside pharmacies, combination of ED pharmacy and e-prescription sent elsewhere, and printed prescriptions with or without any e-prescriptions.

Exposure: Our ED pharmacy is located within the adult ED, serving only patients seen and discharged from the adult ED.

Main outcome(s) and measure(s): Our primary endpoint is to evaluate if prescribing and dispensing prescriptions from only our ED pharmacy is associated with decreased ED revisits within 7 days and reduced hospitalizations within 30 days of initial ED visit.

Results: When comparing patients who received prescriptions only from the ED discharge pharmacy, patients who received no prescriptions were 31.6% (P < 0.001) more likely to revisit our ED, and patients who received e-prescriptions sent to other pharmacies were 10.4% (P = 0.017) more likely to revisit. Patients who received e-prescriptions from other pharmacies were 29.2% (P < 0.001) more likely to be hospitalized and mixture of e-prescriptions were 59.5% (P < 0.001) more likely to be hospitalized compared to the ED pharmacy only group.

Conclusions and relevance: We believe having a pharmacy providing medications to patients being discharged from the ED reduces barriers like cost, transportation, and pharmacy access patients face trying to fill prescriptions at their local pharmacy. All of these reductions in barriers provides an easier and more convenient method for patients to obtain their medications at discharge from the ED, reducing the risk of a repeat ED visit and subsequent hospital admission.

Keywords: Discharge; ED pharmacy; Reducing ED visits and admissions.