Satya Surbhi, PhD

Medication nonadherence is a major barrier to achieving optimal treatment goals. A preliminary analysis showed that only 20.5% of Medicaid super-utilizers (beneficiaries with frequent hospitalizations incurring high health care costs) were adherent to their chronic disease medications following a hospital discharge. Vulnerable patients experience major gaps in care during and after transitions from hospital to community setting. They are often unable to fill all prescriptions immediately after hospital discharge and have poor medication adherence over time. Major barriers to medication adherence after hospital discharge among super-utilizers are financial, transportation, and system-level barriers (not being given all necessary medications prior to discharge). Strategies such as eliminating medication copays and providing medications at hospital bedside and through home delivery improve medication adherence. However, these strategies have not been rigorously assessed in Medicaid super-utilizers. This study is a pilot randomized controlled trial among 60 hospital inpatients in Memphis, Tennessee. Study participants will be randomized to: 1) usual care, 2) full medication subsidy, 3) bedside delivery at discharge and home delivery of medications, or 4) full medication subsidy and bedside delivery and home delivery of medications. The study will examine the impact of these interventions relative to usual care over 3 months on 1) medication adherence, 2) hospitalizations, 30-day readmissions, and ED visits, 3) health care costs, and 4) patient-reported quality of life. By directly addressing the major financial, transportation, and system-level barriers to medication adherence, this pilot study will demonstrate the feasibility of these approaches to improve medication adherence and quality of life while reducing preventable inpatient and ED use and costs among Medicaid super-utilizers.