In an effort to reduce painful relapses and costly readmissions, Wichita’s largest hospital system has joined a program to help make sure patients receive – and use – the medications they need after they’re discharged.
Since the beginning of the year, Via Christi Health has been an outlet for Dispensary of Hope, a Nashville-based nonprofit organization that provides medicine for distribution to patients who can’t afford to pay for it.
Dispensary of Hope gathers pharmaceutical samples and other surplus medications from manufacturers and doctors’ offices and redistributes them across the country to participating pharmacies.
The pharmacies can then provide the medications at no cost to patients who are uninsured and have income of less than twice the federal poverty level – roughly $31,000 for a family of two – said Mark Gagnon, who manages the outpatient pharmacy at the Via Christi Hospital on St. Francis.
Gagnon said the outpatient pharmacy has obtained at least $20,000 worth of medications from Dispensary of Hope, which are shelved and distributed separately from the pharmacy’s regular stocks of medicines for sale.
So far, the hospital has filled 38 prescriptions for 19 patients using Dispensary of Hope medications.
“That’s just in the one month we’ve been doing that,” Gagnon said.
A 2011 study by a University of Arizona researcher estimated that $2.2 billion worth of pharmaceutical samples expire on doctors’ shelves and go to waste each year.
For patients, those medications can be a financial godsend.
For example, one of the more popular medications for patients who leave the hospital is Xarelto, an anti-coagulent prescribed to prevent blood clots and strokes, Gagnon said.
Via Christi recently obtained Xarelto samples from Dispensary of Hope, neatly packaged in five-tablet bottles, he said.
Gagnon said the pharmacy would give a qualifying patient enough of the small bottles to cover 30 days of dosages. The same medication would retail for about $265, Gagnon said.
The Dispensary of Hope operation at Via Christi is based in the regular in-house outpatient pharmacy that opened in September at St. Francis.
The pharmacy is not open to the general public, but only to patients in or recently treated by the hospital or its emergency room and employees of the hospital itself, Gagnon said.
The purpose behind both the regular hospital pharmacy and the Dispensary of Hope sub-pharmacy is to try to keep people who leave the hospital from having to come back.
A Medicare study found that about one out of five elderly patients are readmitted within 30 days, costing the nation $15 billion a year. According to a study by the PricewaterhouseCoopers’ Health Research Institute, overall preventable hospital readmissions cost about $25 billion annually.
Under the Affordable Care Act, hospitals can face financial penalties for excessive rates of readmission for certain diseases and conditions.
But beyond the cost is the human dimension. “It’s the right thing to do for patients, to try to keep them out of the hospital if we can,” said Robyn Chadwick, senior director of case management for Via Christi.
She said Via Christi hospitals are committed to a national goal of reducing readmission 20 percent by 2020.
Poor compliance with post-hospital medication plans is one of the biggest drivers of preventable readmissions.
Chadwick and Gagnon said there are several common reasons people either don’t get or don’t take the medications they should after they’re out of the hospital:
• People who are discharged from the hospital may not have access to medications they can afford, or lack transportation to and from a pharmacy.
• Outgoing patients sometimes think it’s all right to delay filling a prescription until after they see their regular doctor, which could be a week or more after they are discharged.
• When they return home, patients may take their new medications, plus whatever prescriptions they were taking before going into the hospital. This can result in conflicts and excessive dosages of the same medicines.
• Discharged patients may revert to taking a drug they were prescribed earlier in their illness rather than their new prescription. Even if it’s the same drug, the older pills could be a different dosage.
• After leaving the hospital, a person might start feeling better and stop taking his or her medication. This is especially a problem with antibiotics that need to be taken for a specified period of time to fully eradicate an infection.
Having a pharmacy in the hospital allows pharmacists and nurses to work with patients to make sure when they leave, they’re carrying all the medications they’ll need at home – along with the knowledge of when, how and why to take them, Chadwick said.
The hospital can also work with family members and/or recommend electronic medication monitors for patients with mental conditions who would otherwise have a hard time remembering to take their pills when they should, Chadwick said.
“That’s about as far as we can go short of going to their homes and making sure they take them,” she said.