“Patients have little to no copay on the medications, which are all relatively inexpensive. There are no chronic or high-cost medications in the kiosk,” Dr. Santalo said. “The price is determined by the cost of meds, plus the fees and labor. That’s how we’re breaking even. There’s no markup like with a regular pharmacy.”

The initiative began with research to confirm the rate at which patients were actually driving those long distances in the middle of the night (or otherwise) to pick up their prescriptions written in the ED. They found that there was a 30 percent prescription abandonment rate. Additionally, it turns out that when patients don’t pick up their medications, they frequently end up back at the ED; some are admitted to the hospital.

“The kiosks are preventing prescription abandonment by 30 percent, there’s a five percent reduction in ED revisits for kiosk patients versus opted out patients, and overall, ED revisits in 72 hours and 30 days are trending downward with the ability to use prescription drug insurance, which we started in June,” Dr. Bennett said. “We’re also seeing a significant impact on ED revisits resulting in admissions, with a five to seven percent reduction.”

Barriers to Implementation

There were some barriers to implementation at first because of the culture shift. “When you open a pharmacy, it’s solely that pharmacy’s responsibility to get the prescriptions,” Dr. Santalo said. “Whereas with the kiosk, the pharmacy’s work is done remotely.”

Additionally, there was also a bit of extra work for nursing staff as they facilitated delivery of the medications, as well as for physicians who had to change the specific ways in which they write prescriptions. “It was a culture shift, but ultimately everyone bought in because this has a positive impact on the patient, their care, and our community,” Dr. Bennett said.

Most uplifting of all for Dr. Santalo was that when he and Dr. Bennett presented the project proposal to AdventHealth’s finance leadership, they saw value in it and felt it made sense, even if they would not make money on it. “That makes me know I’m working for the right organization and that we are mission-driven,” Dr. Santalo said.

Renée Bacher is a freelance medical writer located in Baton Rouge, La. She is a frequent contributor to Wiley medical trade publications including ENTtoday, ACEP Now, and The Rheumatologist.