Assessment of a ‘Meds-to-Beds’ Approach to Improve Hypertensive Control in the Postpartum Period

Background: Hypertensive disorders of pregnancy are one of the leading causes of maternal morbidity and mortality worldwide. They are also the leading cause of hospital readmission in the postpartum period. At the time of hospital discharge, various barriers prevent women from receiving anti-hypertensive medication. These include, but are not limited to, child-care needs and availability of transportation. The ‘Meds-to-Beds’ initiative helps overcome these barriers by ensuring that patients receive their prescription medications prior to leaving the hospital. Although Meds-to-Beds programs have been implemented to improve disease control and reduce readmission rates in other specialties, there is a lack of data regarding its use for postpartum discharge in obstetrics. We hypothesized that implementation of an educational intervention to train Obstetrics & Gynecology (Ob/Gyn) resident physicians in the utilization of a Meds-to Beds protocol to provide anti-hypertensive medications prior to discharge from labor and delivery (L & D) will lead to: 1) an increase Meds-to-Beds utilization and 2) fewer postpartum readmissions for poorly controlled hypertension. Purpose Statement/Objective: Increase Meds-to-Beds utilization for anti-hypertensive medications at a university-affiliated hospital L&D unit and assess the impact of this intervention on postpartum hypertensive control. Methods: This study was approved by the local Institutional Review Board under protocol IRB #23-396. In preparation for this study, the frequency of Meds-to-Beds utilization for anti-hypertensive medications at our L&D unit in the year 2022 was determined. Baseline demographic information was collected as well as the frequency of postpartum readmission and clinic follow up. The Department of Ob/Gyn residents were then informed about the Meds-to-Beds service during weekly educational conferences. Following resident education, post-intervention data was collected from 8/12/2024 – 02/10/2025. These data included the frequency of Meds-to-Beds utilization for anti-hypertensive medications, demographic information, postpartum readmission rates and the frequency of clinic follow-up. Inclusion criteria were those patients that delivered at our university-affiliated hospital who were prescribed a new anti-hypertensive medication or a new dose of anti-hypertensive medication upon hospital discharge. Those discharged from the hospital on a weekend or major holiday when the hospital’s outpatient pharmacy is closed, as well as non-English speakers were excluded from the study. Continuous variables were summarized as means ± S.E.M. and categorical variables were reported as frequencies (percentages). The pre- and post-intervention categorical variables were compared using the chi-squared test. Results: 435 patients met the study inclusion criteria. We excluded 131 patients who were discharged on weekends and holidays and 4 non-English speakers. Ultimately, 300 records were analyzed—213 baseline records from 2022 and 87 post-intervention records. When demographics were compared, type of insurance, age, parity and tobacco use were not significantly different before vs. after the educational intervention. The percent of new anti-hypertensive drugs prescribed with Meds-to-Beds was significantly higher post-intervention compared to pre-intervention (38% vs. 7%, respectively; p<.0001). The percent of new doses of existing anti-hypertensive drugs prescribed with Meds-to-Beds was significantly higher post-intervention compared to pre-intervention (42% vs. 12%, respectively; p<.0001). However, readmission within 30 days was not different between pre- and post-intervention (7% vs. 8%, respectively; p=0.762). Conclusions: Ob/Gyn resident education resulted in a significant improvement in the utilization of Meds-to-Beds for new anti-hypertensive medications and new doses of existing anti-hypertensives. The 30-day readmission rate remained unchanged. Despite this improvement in Meds-to-Beds utilization (currently at 40%), further improvements can be made by making Meds-to-Beds the default route of prescribing any medications at the time of hospital discharge in the electronic medical record. In addition, increased patient awareness during the prenatal period and nursing education can further increase utilization. With continued Meds-to-Beds utilization, we hope to demonstrate improved postpartum hypertensive control through fewer readmissions and better medication adherence.