Epinephrine auto-injector use and demographics in a Veterans Administration population

Abstract

The epinephrine auto-injector has been widely used over a long period of time. Certain aspects of this therapy and demographic data, however, have not been well studied. This study investigates patient use and understanding of epinephrine auto-injector use. As part of an ongoing quality assurance program, we evaluated 66 patients who had been given an epinephrine auto-injector and followed in the Allergy and Immunology Clinics at the West Los Angeles Veterans Medical Center. Data analyzed included patient demographics, medical indications for epinephrine auto-injector prescriptions, and the patient's understanding and use of the device. The mean age of our patients was 50 years. There were 44 men (66.7%) and 22 women (33%). Twenty-three patients were prescribed epinephrine auto-injector for adverse food reactions. Ninety-two percent (92%) of the patients knew how to use their epinephrine auto-injector properly, however, only 58% carried their device with them consistently. Of the patients, 91% understood why the auto-injector was prescribed. Of the total patients prescribed epinephrine auto-injector, 79% refilled their medication before the 1 year expiration date. Only 12% of the patients studied had required the use of their auto-injector. Most patients knew how and when to administer their epinephrine auto-injector. Despite detailed instructions in a specialty clinic only a slight majority carried it consistently. These data clearly indicate that further patient education or other measures are needed to improve compliance and effective use.

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

“…evaluated nearly 15,000 patients in a health maintenance organization (HMO) over a 6‐year period and found that less than 50% refilled their EAI even once and that only 11% refilled consistently at all expected refill times. Several studies performed over the last 15 years have consistently shown that only 50% to 60% of patients carry their EAI with them regularly and can produce them at their office visits …”

The Ability to Use Epinephrine Autoinjector in Patients Who Receive Prescription Immediately after Anaphylaxis

“…The study of Sirin [3] recommends that training be repeated every 6 months. Several studies have shown that less than 60% of patients carry their EAI with them regularly [19].…”

Diagnosis and Management of Insect Allergy: Barriers and Facilitators in the United States

“…When evaluating patient-driven barriers to prompt epinephrine administration during an event, a study of 66 patients who had been prescribed an EAI at an Allergy and Immunology clinic at a VA medical Center revealed that 92% of patients knew how to use their EAI properly but only 58% consistently carried their device. 45 Cost to the patient may also hinder access. In a survey of 917 patients in the US who had been prescribed an EAI, 89% reported filling prescriptions; however, of the ones who did not, 25% cited that cost as the reason.…”