title: To-Go medications for decreasing ED return visits.
abstract: OBJECTIVE
  The primary objective was to determine if providing patients with a complete course of antibiotics for select conditions would decrease the rate of return to the emergency department (ED) within 7 days of the initial visit.
  
  
  METHODS
  In an urban, academic medical center, we compared patients who received medications at discharge (To-Go medications) with patients who received standard care (a prescription at discharge). Emergency department patients were included if they were older than 18 years; had a discharge diagnosis International Classification of Diseases, Ninth Revision, code for urinary tract infection, pyelonephritis, cellulitis, or dental infection; and presented initially between January and December 2010. Candidates had limited health insurance or were discharged when nearby pharmacies were closed. Return visits were included if the condition was related to the initial diagnosis. Wound checks and scheduled revisits were excluded. Medications dispensed were penicillin, clindamycin, sulfamethoxazole-trimethoprim, and nitrofurantoin.
  
  
  RESULTS
  A total of 4257 individuals were seen in initial ED visits for the included conditions. Comparing the 243 individuals given medications with the 4014 who were not given medications, the To-Go medications group was less likely to return than the comparison group (2.5% vs 5.9%; P = .026). The cellulitis subgroup also showed a significant reduction in return visits (1.6% vs 6.9%; P = .024). Three hundred eighteen courses of medication were given to the 243 individuals for a total cost of $1123.
  
  
  CONCLUSIONS
  For a 1-year expense of $1123, we demonstrated a 50% reduction in ED return visits for patients who were given a free, complete course of antibiotics at discharge for select conditions.
authors.affiliation: Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD 21201, USA. bryan.hayes@alumni.mcphs.edu
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Hayes
authors.forename: Leila
authors.initials: L
authors.lastname: Zaharna
authors.forename: Michael E
authors.initials: ME
authors.lastname: Winters
authors.forename: Agnes Ann
authors.initials: AA
authors.lastname: Feemster
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Browne
authors.forename: Jon Mark
authors.initials: JM
authors.lastname: Hirshon
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy; D016527:Drug Costs; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005491:Focal Infection, Dental / Q000188:drug therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010351:Patient Discharge; D011704:Pyelonephritis / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents