title: Evaluation of a discharge medication service on an acute psychiatric unit.
abstract: BACKGROUND
  Nonadherence with medication is a major factor that influences acute psychiatric hospital readmission. Pharmacists can positively influence rapid psychiatric readmission due to nonadherence by counseling patients and providing filled prescriptions on discharge.
  
  
  OBJECTIVE
  This study is a retrospective evaluation of a pharmacist-driven discharge medication service for hospitalized psychiatric patients. Measured outcomes include a comparison of rapid readmissions pre and post implementation. Rapid readmissions between the concurrent study group and excluded group were also compared.
  
  
  METHODS
  From October 2010 to November 2011, home-destined subjects being discharged from the hospital's behavioral health unit were provided filled psychiatric prescriptions for self-administration upon discharge, coupled with medication counseling. A series of statistical comparisons were made between the 2 prior years' overall rapid readmissions. This was subsequently compared with the overall rapid readmission rate during the study year. The study group's rapid readmissions were then compared to the overall rapid readmission rate of the study year as well as to the concurrent excluded group.
  
  
  RESULTS
  Thirty-day hospital readmissions were found to be significantly decreased in studied subjects compared to total rapid readmissions during the previous year (P = .004) and to the excluded group (P = .020).
  
  
  CONCLUSIONS
  Immediate availability of prescriptions upon discharge, coupled with development of therapeutic alliances with patients, removes some of the barriers to patient medication adherence in the discharged, acute psychiatric patient. The program provided positive outcomes with regard to decreased frequent, rapid readmission to the acute care psychiatric unit due to medication nonadherence.
authors.affiliation: Assistant Professor of Pharmacy Practice and Clinical Pharmacy Specialist, Department of Pharmacy, Duquesne University and UPMC Mercy Hospital, Pittsburgh, Pennsylvania.
authors.forename: John R
authors.initials: JR
authors.lastname: Tomko
authors.affiliation: Director of Inpatient Psychiatric Services.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania.
authors.forename: Koushik
authors.initials: K
authors.lastname: Mukherjee
authors.affiliation: Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Roma
authors.affiliation: Department of Nursing Services, Utilization, UPMC Mercy Hospital, Pittsburgh, Pennsylvania.
authors.forename: Donna
authors.initials: D
authors.lastname: Dilucente
authors.affiliation: Pharmacy Manager, UPMC Mercy Ambulatory Pharmacy, Pittsburgh, Pennsylvania.
authors.forename: Karen
authors.initials: K
authors.lastname: Orchowski
keywords: hospital readmission; medication adherence; pharmacist; prescriptions; psychiatry; therapeutic alliance