Distance to pharmacy and risk of medication primary nonadherence.

Primary nonadherence, a form of prescription nonadherence, is defined as failure to fill and pick up a prescription medication. Little is known about the relationship between distance to pharmacy and primary nonadherence in dermatology. In this study, we investigated the association between primary nonadherence and distance between a patient's home and pharmacy. We focused on a low-income patient population within the dermatology clinic of a large, urban county hospital system in which patients were enrolled in a pharmacy benefit within a closed-system. Among 678 patients who were prescribed a total of 1156 prescription medications for dermatologic conditions, 11.7% did not pick up any of their prescriptions. After adjusting for patient demographics of race/ethnicity, sex, age, language, and relationship status, there was no association between primary nonadherence and distance traveled between a patient's home and pharmacy. Results of this study are consistent with other studies in non-dermatologic patients and suggtableest that distance from a pharmacy may not be strongly associated with primary nonadherence for dermatologic medications.

Impact of a Quality Improvement Initiative to Optimize the Discharge Process of Pediatric Gastroenterology Patients at an Academic Children's Hospital.

Discharge is an important and complex process that can be optimized to reduce inpatient healthcare inefficiency and waste. This study aimed to increase the percentage of patients discharged before 1 pm by 20% from an academic inpatient pediatric gastroenterology service (IPGS), over 6 months. METHODS: We conducted a preintervention and postintervention study of patients discharged from IPGS. Patients discharged from January to June 2016, and those following our intervention from June to December 2016, were studied. Interventions included (1) implementation of the electronic medical record medical and logistical discharge criteria checklists for the 4 most common IPGS discharge diagnoses, (2) standardization of the rounds process to prioritize discharge, (3) education of nursing staff and families about the role they played in discharge. Process, outcome, and balancing measures were analyzed. RESULTS: Three hundred fifty-five total discharges were studied. Between the preintervention and postintervention groups, there were no significant improvements in discharge order time, physical discharge time, discharge response time, or discharges before 1 pm. The balancing measure of 30-day readmission was unaffected. However, length of stay (LOS) index, calculated as the ratio of actual to expected LOS, improved; when translated into days, LOS declined by 1 day, with potential associated savings of $373,000. CONCLUSIONS: Interventions to improve discharge timeliness on IPGS service demonstrated mixed effectiveness. Only LOS index improved. Further iterative quality improvement interventions are needed to continue optimizing discharge timeliness and change the culture of pediatric discharge on inpatient subspecialty services in academic children's hospitals.