School of Medicine and Health Sciences Poster Presentations

Title

Pediatric Prescription Fill Rate for Bacterial Infections after Discharge from the Pediatric Emergency Department

Document Type

Poster

Abstract Category

Prevention and Community Health

Keywords

prescription, fill rate, pediatrics, emergency department

Publication Date

Spring 5-1-2019

Abstract

Background: Antibiotics are frequently prescribed in the pediatric emergency department (PED), but fill rates after ED discharge are unknown. Medication nonadherence is associated with increased emergency department visits and adverse health outcomes. Objective: To determine antibiotic prescription fill rate overall and by disease category upon discharge from an urban PED. Methods: We performed a retrospective medical record review of PED visits by children aged 0-21 years from Jan 1, 2018 through March 31, 2018, during which oral antibiotics were prescribed to pharmacies participating with Surescripts e-prescribe network as our electronic health record records when these prescriptions are filled. Common diagnoses were grouped using ICD-10 codes for diseases categories of otic, respiratory, urinary, soft tissue/skin infections, and other. Multivariable logistic regression models were used to determine the association of prescription fill rate with diagnosis category after adjustment for patient-level (age, gender, insurance status, interpreter use) and visit-level (diagnosis, triage level) characteristics. Results: There were 2886 patients with an oral antibiotic prescription. The mean age of patients was 5.6 (+/-4.7) years, and the majority was male (53.3%), publicly insured (70.4%) and Non-Hispanic black race (62.7%). The overall antibiotic prescription fill rate was 66.3% (95% CI: 64.5, 68.0). The fill rate by disease category was: 69.1% for sinusitis, 69.1% for respiratory, 68.1% for pharyngitis , 66.7 % for lymphadenitis, 66.5% for soft tissue /skin infections, 65.9% for otic infections, 60.0% for UTI, 64.5% for other and 71.2% if more than one of the above were diagnosed. After adjusting for demographic factors, no differences were identified in prescription filling by diagnosis. Discussion: Nearly 40% of patients with bacterial infections discharged from this pediatric ED do not fill their prescriptions. This is the largest study to date of outpatient pediatric ED antibiotic prescription fill rates. The data indicates a timely need to better understand barriers to treatment adherence.

Open Access

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Presented at Research Days 2019.

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Pediatric Prescription Fill Rate for Bacterial Infections after Discharge from the Pediatric Emergency Department

Background: Antibiotics are frequently prescribed in the pediatric emergency department (PED), but fill rates after ED discharge are unknown. Medication nonadherence is associated with increased emergency department visits and adverse health outcomes. Objective: To determine antibiotic prescription fill rate overall and by disease category upon discharge from an urban PED. Methods: We performed a retrospective medical record review of PED visits by children aged 0-21 years from Jan 1, 2018 through March 31, 2018, during which oral antibiotics were prescribed to pharmacies participating with Surescripts e-prescribe network as our electronic health record records when these prescriptions are filled. Common diagnoses were grouped using ICD-10 codes for diseases categories of otic, respiratory, urinary, soft tissue/skin infections, and other. Multivariable logistic regression models were used to determine the association of prescription fill rate with diagnosis category after adjustment for patient-level (age, gender, insurance status, interpreter use) and visit-level (diagnosis, triage level) characteristics. Results: There were 2886 patients with an oral antibiotic prescription. The mean age of patients was 5.6 (+/-4.7) years, and the majority was male (53.3%), publicly insured (70.4%) and Non-Hispanic black race (62.7%). The overall antibiotic prescription fill rate was 66.3% (95% CI: 64.5, 68.0). The fill rate by disease category was: 69.1% for sinusitis, 69.1% for respiratory, 68.1% for pharyngitis , 66.7 % for lymphadenitis, 66.5% for soft tissue /skin infections, 65.9% for otic infections, 60.0% for UTI, 64.5% for other and 71.2% if more than one of the above were diagnosed. After adjusting for demographic factors, no differences were identified in prescription filling by diagnosis. Discussion: Nearly 40% of patients with bacterial infections discharged from this pediatric ED do not fill their prescriptions. This is the largest study to date of outpatient pediatric ED antibiotic prescription fill rates. The data indicates a timely need to better understand barriers to treatment adherence.