Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA.
Medical Affairs, Becton Dickinson, Downer's Grove, IL, USA.
Am J Health Syst Pharm. 2022 Aug 19;79(17):1438-1444. doi: 10.1093/ajhp/zxac145.
Discharge prescriptions represent an important aspect of care for patients seen in the emergency department (ED) setting and are used by providers to continue therapy for acute illness once patients leave the ED or to prevent future exacerbations of chronic conditions. The success of an ED discharge and the medications prescribed rely on patient compliance. Compliance depends on patients' ability to obtain prescriptions, which can be hindered by limited access to pharmacies and cost.
In order to address issues traditionally associated with medication noncompliance, a discharge pharmacy was implemented within a busy urban ED. The pharmacy began processing prescriptions on December 18, 2019, using a formulary aimed towards providing commonly prescribed and high-risk medications. The pharmacy accepts insurance plans in addition to utilizing 340B Drug Pricing Program pricing to offer affordable medications to patients. During the first year of operation 10,230 prescriptions were filled for 5,703 patients, representing 13% of all patients discharged during that time. Of the prescriptions filled, 35.4% were for products considered high-risk medications, including epinephrine auto-injectors, insulin, and antibiotics. Over 50% of these high-risk medications were provided to patients through reduced cash pricing. Pharmacist interventions were made on 4.3% of prescriptions to address incorrect dosing, avoid use of inappropriate antibiotics, and recommend alternative therapies.
The implementation of a discharge pharmacy within the ED allowed over 5,700 patients to be discharged with medications and represents a potential solution to issues surrounding medication noncompliance. Similar initiatives have the opportunity to improve medication access for a larger ED population.
出院处方是急诊科（ED）患者护理的一个重要方面，医生用它来为急性疾病患者在离开 ED 后继续治疗，或预防慢性疾病的恶化。ED 出院和开的药物能否成功取决于患者的依从性。依从性取决于患者获取处方的能力，而这可能会受到药房数量和成本的限制。
为了解决与药物不依从性相关的传统问题，在繁忙的城市 ED 内设立了出院药房。该药房于 2019 年 12 月 18 日开始处理处方，使用的处方集旨在提供常用和高风险药物。该药房接受各种保险计划，同时利用 340B 药品定价计划，为患者提供负担得起的药物。在运营的第一年，为 5703 名患者开了 10230 张处方，占当时出院患者的 13%。在开出的处方中，35.4%是高风险药物，包括肾上腺素自动注射器、胰岛素和抗生素。超过 50%的这些高风险药物通过降低现金价格提供给患者。药剂师对 4.3%的处方进行了干预，以解决剂量错误、避免使用不合适的抗生素以及推荐替代疗法的问题。
ED 内设立出院药房使 5700 多名患者出院时能拿到药物，这是解决药物不依从性问题的一个潜在方法。类似的举措有机会改善更大 ED 人群的药物获取。
