Pediatric prescription pick-up rates after ED visits

https://doi.org/10.1016/j.ajem.2004.10.015Get rights and content

Abstract

Objective

To determine the compliance rate in filling outpatient medication prescriptions written upon discharge from the emergency department (ED).

Methods

Emergency department records of children during a 3-month period were examined along with pharmacy claim data obtained in cooperation with the largest insurance carrier in the community (private and Medicaid). Pharmacy claim data were used to validate the prescription pick-up date.

Results

Overall, 65% of high-urgency prescriptions were filled. The prescription pick-up rate in the 0-to 3-year age group (75%) was significantly higher than in the rest of the cohort (55%) (P < .001). Children with private insurance were more likely to fill their prescriptions (68%) compared to children with Medicaid insurance (57%) (P = .03).

Conclusion

This study demonstrates that filling a prescription after discharge from an ED represents a substantial barrier to medication compliance.

Introduction

Patients discharged from the emergency department (ED) are commonly prescribed drugs for the management and treatment of disease. Disease prognosis and drug efficacy are dependent upon patient compliance with prescribed medications. Compliance with drug therapy is essential as many ED patients do not obtain follow-up evaluations [1], [2], [3], [4]. Repeat ED visits and subsequent hospital admissions have also been associated with prescription drug noncompliance [5], [6].

The first requirement for outpatient medication compliance is to actually obtain the medication. Prescription pick-up rates for patients discharged from EDs have been found to range between 44% and 92% [7], [8], [9], [10], [11], [12], [13], [14]. Although previous studies have used patient surveys to determine this, few have confirmed that patients obtained their medication using actual insurance claim data. In addition, there is little information on prescription pick-up rates in pediatric populations.

The purpose of this study is to estimate pediatric prescription pick-up rates after an ED visit and to assess factors associated with unfilled prescriptions.

Section snippets

Methods

This is a retrospective study examining ED medical records at a children's hospital. Pharmacy claim information was provided by the largest insurance provider in the state, which provides Medicaid and private insurance to approximately half of the state's population. Daily ED records were reviewed to identify pediatric patients (age under 18 years) covered by this insurer who were discharged from the ED with a high-urgency drug prescription during a 3-month period (April 1, 2001-June 30, 2001).

Results

There were 6354 total records reviewed during the 3-month study period, with 1829 excluded as adult patients (age ≥18). Of the remaining 4525 pediatric patient records, 2123 were covered by the participating health plan (47%). Of those remaining records, 1334 were eliminated because of hospital admission or no medication prescribed upon discharge. Of the remaining 789 patient records, 403 were prescribed high-urgency medications and are further described below.

The mean age of these 403 children

Discussion

Children represent a unique population for prescription filling as compliance is dependent on the reliability of their parents or guardians [14], [15], [16], [17] In addition, other factors such as insurance type, income level, age of the child, and ethnicity have been shown to be important factors affecting compliance [13], [14], [18], [19], [20]. Although most published studies on prescription filling for patients discharged from the ED have focused on adults [7], [8], [9], [10], [11], our

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    An abstract of this study has been presented at the American College of Emergency Physicians Research Forum, Boston, MA, October 2003, and the Emergency Medicine Section of the American Academy of Pediatrics National Conference and Exhibition, New Orleans, LA, October 2003.

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