Purpose: As health care progresses toward pay for performance reimbursement models and focus is placed on the patient as a consumer, health care systems must adapt by initiating new programs and services. This institution responded by implementing a “Meds 2 Beds” program integrating clinical services with dispensing and medication delivery during transitions of care. This study evaluates outcomes relevant to patients, health care providers, pharmacists, and administrators. Methods: This observational chart review evaluated the effectiveness of a “Meds 2 Beds” program from May 1, 2014, through December 1, 2015. Patients who participated in this program were matched 1:1 with controls who did not. The primary outcome was 30-day hospital readmission. Secondary outcomes included 30-day emergency department (ED) visits, patient satisfaction, and financial impact. Results: In this sample, 185 “Meds 2 Beds” patients were matched to 185 controls. Thirty day readmission occurred in 16 (8.7%) “Meds 2 Beds” cases and 19 (10.3%) controls ( P = .71). Rates of 30-day ED visits were nonsignificantly reduced in cases (22 [11.9%] vs 33 [18.1%]; odds ratio = 0.62, P = .11) and occurred significantly later (11 vs 7 days, P = .03). Conclusions: This study showcases a creative medication delivery and discharge counseling program. The program provides financial benefit to the institution creating a direct revenue stream from prescription dispensing while highlighting a potential for reduced readmissions and ED visits (although a statistically significant difference was not demonstrated in this analysis). A similar model can be adopted by other health care institutions to improve the quality of patient care.

| INTRODUC TI ONWidespread implementation of safe and effective oral direct-acting antiviral (DAA) regimens has led to a revolution in the treatment of chronic hepatitis C virus (HCV) infection, a major cause of cirrhosis and hepatocellular carcinoma. Before the advent of DAA regimens, the standard of care for HCV treatment was subcutaneous polyethylene-conjugated interferon alpha (peginterferon) in combination with oral ribavirin, administered for up to 48 weeks. Incomplete on-treatment virological suppression or virological relapse resulted in rates of sustained virological response (SVR) of approximately 50% overall, 1 defined (in the peginterferon era) as the absence of detectable serum HCV RNA 24 weeks after treatment completion. Frequent laboratory monitoring was necessary throughout the treatment course due to the risk of haematologic toxicities of peginterferon and ribavirin. Furthermore, the kinetics of reduction in serum HCV RNA during treatment were used to guide the duration of antiviral therapy, which required measurement of serum HCV RNA at multiple time points during and after treatment. 2With the high SVR rates (greater than 90% overall) and absence of haematological toxicities associated with ribavirin-free DAA regimens, the need for frequent laboratory monitoring, and in particular, determination of on-treatment kinetics of virological suppression, is less clear. With DAA treatment, confirmation of SVR can be achieved by measurement of serum HCV RNA only 12 weeks after treatment completion; thus current monitoring recommendations, codified in joint guidelines from the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA), include determination of serum HCV RNA at week 4 of DAA-based treatment and at 12 weeks after treatment completion. 3 However, the guidelines leave open decision making about serum HCV RNA determination at the end of treatment. 3 Many centres, including our own, have continued to test at end-treatment in this interferon-free era, but the utility of this practice has not been established. To address this unresolved issue, we sought to determine the extent to which testing at week 4 and the end of ribavirin-free DAA treatment predicted SVR and whether it identified unexpected drug toxicity that would alter post-treatment management. completed all laboratory follow-up. Baseline data included demographic information, HCV genotype, previous antiviral treatment if applicable, and DAA regimen used. Cirrhosis was defined by (a) abdominal imaging, (b) liver stiffness of at least 12.5 kPa, measured by transient elastography, or of at least 4.81 kPa, measured by magnetic resonance elastography, or (c) biopsy. 4 Exclusion criteria included the following: (a) concomitant hepatitis B infection (defined as the presence of detectable serum hepatitis B surface antigen), (b) Abbreviations: AASLD, American Association for the Study of Liver Diseases; ALT, serum alanine aminotransferase; AST, aspartate aminotransferase; DAA, direct-acting an...

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