COPD Readmissions Not Impacted by Delayed Prescription Fills

In an effort to reduce 30-day readmission rates as well as the reimbursement penalty from the Centers for Medicare and Medicaid Services, recent research by Aaron Kovacik, PharmD, and colleagues, examined the impact of delayed prescription fill on these measures. The research team found that patients with chronic obstructive pulmonary disease (COPD) who had delayed discharge prescription fills did not have an increase rate of readmission.

In order to identify an association between delayed prescription fills and readmission rates to determine if programs that provide patients with their medications before discharge were valid, the researchers performed a retrospective chart review. The observed patient charts were of patients who were admitted to Henry Country Medical Center with a COPD exacerbation from January to October 2016.

After contacting outpatient pharmacies, researchers compared the time to fill prescriptions with the time of patient discharge. The patients were then separated into 2 subgroups—those who filled within 48 hours of discharge and those who filled after 48 hours.

“The primary outcome was 30-day readmission rate, and a secondary end point was to identify patient characteristics associated with delayed prescription fills,” Dr Kovacik and colleagues wrote.

According to the findings, of the 104 patients included in the study, patients with COPD experienced a lower readmission rate when prescription fills were delayed at least 48 hours. The researchers reported no baseline characteristics that were associated with significantly higher rate of delaying prescription fill.

INSIGHT FROM THE AUTHOR

I think the biggest issue that caused the COPD results can be attributed to our limited sample size. I would be interested to see if a different trend would be seen in a larger study. But one of the other possible factors that could impact the data is that we could not tell whether some of these patients were discharged with additional supplies that could have bridged a gap during the delay in prescription fill (such as inhalers, nebulizerses with a breathing machine, and/or oxygen for home use).

I would still expect a longer delay period to increase readmission rate though it would not have shown as such in our population in this study.

How do COPD readmissions impact overall health care costs for patients and providers?

Reducing these readmissions would lower health care costs, but even more important is that it can help protect smaller, rural hospitals that have been struggling with the recent changes to Medicare/Medicaid reimbursement. I think the importance of these smaller institutions can be overlooked at times especially for more secluded areas of the country. Also addressing issues with prompt fill of prescriptions should reduce morbidity (and possibly even mortality) in our patient population.

It is important to remember that our study did not include ED visits and these visits also affect costs of care nationwide for these conditions that could possibly be lowered by programs allowing for prompt discharge prescription fill.

Do you have any further comments on this study?

My only further comment on the study is to leave readers with this idea:

If we can show a statistically significant correlation between delayed fill and readmission, I think it will be an important push towards targeting barriers to prompt fill more aggressively at discharge. I think it would be interesting for hospitals in the future to consider the possibility of discharging patients with a 24-48 hour "emergency supply" of medications to bridge the gap between discharge and prescription fill. The cost of these medications compared to the cost of a readmission within 30-days is much more favorable to the institution. But I think that would require future studies more focused on the cost-efficiency of such a program.

—Julie Gould

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