Ronald Griffin hugged his pill box like a teddy bear.
"This is my best friend," he said with a smile, clutching the large translucent plastic container to his chest and lying back in his bed at Erlanger hospital on Third Street.
Two weeks ago, the 66-year-old Chattanooga native had a kidney transplant, after four years of making the trip to Erlanger three times every week for dialysis.
He is in the hospital on this Wednesday morning for a screening, to be certain the prescriptions he is taking are preventing his body from rejecting his new organ.
"I can't do this by myself," he said, referring to how hard it is to keep track of his daily pill intake.
Griffin, who moved back here five years ago from California to take care of his mother, has prescriptions for 17 separate medications. There are pink pills and blue ones, some that are pill-shaped and others triangular, a total of about 35 he must take every day.
Some are to be taken three times a day, some twice; some every other day and still others as needed. This one goes with a meal, this one before it, that one afterward.
If Griffin — with help from his family and friends — can keep on top of his medications, he will be fine. But if he slips up, he risks losing his new kidney and ending up back on dialysis.
To prevent that from happening, Erlanger's pharmacy has special programs focused on making sure patients have their prescriptions filled and that they understand how to take them before they leave the hospital.
"Sometimes they take them wrong, sometimes they don't go to the pharmacy to get them filled because they are too expensive," said Paul Smith, a case manager at Erlanger. "We're trying to find ways for patients to have these in hand so that they don't have those excuses as a reason to come back."
A study published in 2010 concluded failure to manage prescriptions is one of the major reasons patients end up back in the hospital, Smith said. He manages Care Transitions, a program that focuses on proper prescription use by Medicare patients who are likely to be re- admitted, including those with pneumonia, stroke, congestive heart failure, orthopedic problems, chronic obstructive pulmonary disease and acute myocardial infarction.
According to the federal Food and Drug Administration, between 20 and 30 percent of all patients never fill their prescriptions, and 50 percent of the time medication is not taken as prescribed.
When patients do that, the problems that put them in the hospital in the first place often return. But increasingly, doctors are realizing one of the best ways to improve care is to spend extra time making sure patients understand the importance of taking their prescriptions properly.
Previously, Griffin might have been released with a handful of prescriptions to be filled at his local pharmacy, with instructions on how to take them printed on the label.
But instead, as he waited to be released from the hospital, discharge pharmacist Rebecca Walker delivered his medications directly to his room. She sat at his bedside and went over each one. For backup, his discharge paperwork included two pages with a small photo of each pill, along with its common and technical names and instructions for its use.
The hospital will even deliver his prescriptions to his home, for free.
Erlanger is not alone.
CHI Memorial has a similar program, pharmacy director Sandy Vredeveld said.
"We use a risk predictor tool to identify patients at the highest risk of re-admission," she said. The predictor is based on the seriousness of the patient's illness, other medical issues, length of stay in the hospital and the number of times the patient has been to the emergency room.
Those patients get a bedside visit from a pharmacist who reviews their prescriptions and how to take them, Vredeveld said.
"Medications are confusing and complicated," she said. "It's a challenge when you are seeing multiple physicians and specialists and their primary care physician."
CHI Memorial also uses nurses to call patients several days after discharge to check whether they have filled their prescriptions and are taking them properly.
So why don't patients take their prescriptions properly?
Cost is an obvious reason. Erlanger's pharmacists will work with patients before they leave the hospital to determine if they qualify for TennCare or Medicare or any subsidies from drug manufacturers, said Santie deWet, a discharge pharmacist at Erlanger.
Problems with insurers is another. Doctors sometimes prescribe a drug, but when the patient arrives at the pharmacy they learn their insurance company won't pay for it unless they first try another, less expensive, medication, deWet said. Again, Erlanger's pharmacy staff works with insurers to avoid such problems before the patient is released.
But patients often just misunderstand instructions. If the doctor says to take the pill three times a day, some patients will take all of the pills at once, Smith said. That often doesn't work because the reason for spacing out the pills throughout the day is to ensure a steady supply of the medication in the bloodstream. Or they may cut the dosage in half to save money. But the lower dosage may not be effective in treating their problem.
With antibiotics in particular, patients often stop taking their pills when they feel better instead of taking the entire bottle as their doctor ordered, he said. That often means the infection isn't completely eradicated and may come back.
Another problem is when patients share drugs with others who they believe have similar ailments.
"Your medications are prescribed for you for your problems, and with the knowledge that they are based on other drugs you are taking," Vredeveld said.
The extra focus on prescriptions seems to work. A study published in July by the CVS Health Research Institute, the research arm of the pharmacy company, concluded follow-up programs lowered hospital re-admission rates by 50 percent and reduced overall costs.
"Many patients may not realize how important some of their prescriptions are," Vredeveld said. "Many are life-saving therapy, and if you don't take them, there will be severe consequences."