Multidose Medication Dispensing on Discharge: Effects on Compliance, Readmissions, and Cost in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Hospital inpatients given multidose medications are often prescribed the same medication to be continued after discharge from the hospital. Commonly, the medication is disposed of at discharge and the patient is given a prescription. COPD is a debilitating disease with a high readmission rate and hospitalization cost. One of the mainstays to stabilize severe COPD patients’ disease is adherence to their multidose inhaled medication regimen after hospital discharge. This study evaluated a clinical service dispensing multidose medications on discharge (MMDD) and providing pharmacist education to specifically target COPD patients.

Methods: This was a quasi-experimental before-after study. The first phase involved creation and implementation of a new clinical pharmacy initiative at the Harris Health System. Patients with COPD on included study multi-dose medications were prospectively identified. Clinical pharmacists responsible for these patients provided the patient with their COPD-related multi-dose medications used during their inpatient stay, along with appropriate medication counseling. Post-discharge fill compliance and 30-day readmission rates were compared before and after implementation of the program. Additionally, the costs of waste disposal charges were compared before and after implementation, and product and labor cost savings were calculated. The study received exempt status by The University of Houston Institutional Review Board and administrative approval by Harris Health System.

Results: One hundred sixteen out of 247 (47%) patients in the pre-intervention group were compliant on the measure of discharge fill compliance, versus 36 out of 36 (100%) in the intervention arm (p<0.001). Eighty-eight out of 412 patients from the pre-intervention group were readmitted within 30 days for an effective rate of 21.4%, versus 4 out of 54 patients who received the intervention for a rate of 7.4% and a relative reduction of 65.4% (p<0.05).

Conclusions: A MMDD program targeting COPD patients was successful in reducing 30-day readmissions and was associated with cost savings.