Hospital systems are working to reduce patient readmission rates, owing to the Affordable Care Act’s program that cuts payments to hospitals for certain readmissions. According to NEHI, a health policy institute, hospitals with excess readmissions for heart failure, heart attack, and pneumonia saw penalties kick in this past October; the penalties could expand in the future to other conditions such as chronic obstructive pulmonary disorder and certain cardiovascular procedures.
Interestingly, hospitals could face such penalties because of a serious failure outside their facilities: poor medication management. In its October brief, “Improving Medication Adherence and Reducing Readmissions,” NEHI cited research estimating that “up to 19% of discharged patients experienced an adverse event after discharge, of which roughly two-thirds were attributed to medications.”
Consequently, medication management programs are part of a number of hospital improvement programs, reports NEHI. These include the Society for Hospital Medicine’s Project BOOST, the American College of Cardiology Hospital to Home Initiative, the Institute for Healthcare Improvement and its State Action on Avoidable Rehospitalizations (STAAR) initiative, and even programs by Kaiser Permanente.
These programs involve several “core attributes,” reports NEHI, such as assigning accountability, encouraging teamwork, ensuring accurate medication reconciliation and clinical management, educating caregivers, and follow up.
But challenges remain. NEHI reports that barriers to medication management and adherence include incomplete and inaccurate patient medication lists, caregiver limitations, poor follow up, and funding challenges.
NEHI also points out that transitional care goes only so far. “Whether patients remain stable and out of the hospital for a longer period depends in part on whether they are actually ‘handed off’ to community providers who can provide the same kind of comprehensive management and adherence services that are the hallmark of the best discharge planning and transitional care services,” the brief reads.
I see an opportunity for medication packaging to make a difference in improving care transitionally and beyond. “Reminder” packaging has been shown to encourage patients to be more adherent and persistent with their treatment regimens, write authors in a study on the use of such packaging. In “Real-World Impact of Reminder Packaging on Antihypertensive Treatment Adherence and Persistence” published this year in Patient Preference and Adherence, the authors studied data on patients taking valsartan-hydrochlorothiazide. Those patients who switched to the drug in reminder packaging demonstrated a medication posssession ratio of 80% compared with 73% for those who did not switch. The reminder packaging studied was MWV Healthcare’s Shellpak provided in Walmart and Sam’s Club pharmacies throughout the United States. (For more from this study visit http://www.dovepress.com/real-world-impact-of-reminder-packaging-on-anti... ).
In addition, according to a spokesperson for MWV, "Novartis has elected to make the Shellpak reminder packaging for Diovan HCT widely available (all pharmacies, not just Walmart and Sam's) despite loss of patent exclusivity last month."
Packaging could be used to encourage adherence and persistence after patients are discharged from hospitals. It will take coordinated efforts from many stakeholders in patient care as well as in the pharmaceutical supply chain to make a difference. But tangible tools are desperately needed so that pharmacists, home-health nurses, caregivers, and patients themselves can follow and track regimen use. Packaging could be such a tool, offering long-term utility.
by Daphne Allen, Editor
This article appeared as the November 2 ePackage Newsletter. An earlier version of this article mistakenly stated that "Those patients who switched to the drug in reminder packaging demonstrated a medication posssession ratio of 80% compared with 76% for those who did not switch."