Epinephrine autoinjector prescription filling after pediatric emergency department discharge

Abstract

Background: There are known racial and socioeconomic disparities in the use of epinephrine autoinjectors (EAI) for anaphylaxis. Objective: To measure the rates of EAI prescription filling and identify patient demographic factors associated with filling rates among patients discharged from the pediatric emergency department. Methods: This was a retrospective observational cohort study of all patients discharged from a pediatric emergency department who received an outpatient prescription for an EAI between January 1, 2018, and October 31, 2019. The rates of prescription filling were calculated, and multivariable logistic regression was performed to identify sociodemographic factors associated with prescription filling. Results: Of 717 patients included in the analysis, 54.8% (95% confidence interval {CI}, 51.1%‐58.5%) filled their prescription. There were no significant associations between EAI fill rates and patient age or sex. In bivariable analysis, non-Hispanic white patients were more likely to fill EAI prescriptions compared with non-Hispanic Black patients (odds ratio [OR] 1.89 [95% CI, 1.11‐3.20]), and patients with in-state Medicaid were significantly less likely to fill EAI prescriptions compared with those patients with private insurance (OR 0.69 [95% CI, 0.48‐0.98]). However, after multivariable adjustment, there was no significant difference in filling by age, insurance status, or race or ethnicity. Conclusions: Only approximately half the patients had their EAI prescriptions filled after discharge. Filling rates did not vary by sociodemographic characteristics.

Trends and determinants of epinephrine prescriptions: a proxy of anaphylaxis epidemiology?

“…Despite the burden of cost being directly indicated as a major reason for not filling the EIA prescription by 14% of the survey participants, the authors correctly speculate that economic issues may underline other apparent reasons, leading the parents to ignore physicians’ recommendations related to the self-injectable epinephrine devices, as suggested by other reports [29]. Similar findings were described by Cohen et al [34] who conducted a retrospective observational cohort study on 717 patients receiving an EAI prescription following a paediatric emergency department access. When evaluating racial and economic variables potentially impacting on prescription filling, the bivariate analysis, although not confirmed by the multivariable adjustment, highlighted that non-Hispanic white ethnicity was associated with a higher probability to fill EAI prescriptions compared with non-Hispanic black one [odds ratio (OR) 1.89 (95% CI 1.11–3.20)].…”

“…Anyway, it seems not to act itself as a determinant impacting on the clinicians’ prescription behaviour related to EIAs, as confirmed by the meta-analysis by Miles et al [33]. A retrospective observational cohort study recently conducted in the United States evaluated EIA prescription after paediatric emergency department discharge between January 2018 and October 2019 [34]. Within the study population, aged 8.1 ± 5.5 years, no significant associations between EAI fill rates and patient age were detected.…”

Improving Care at Emergency Department Discharge for Pediatric Patients with Anaphylaxis Using a Quality Improvement Framework

“…The next phase of the project will include directly dispensing epinephrine autoinjectors in the ED, as it was demonstrated in a recent study at our institution that the epinephrine autoinjector fill rate from ED discharge prescriptions was only 54.8%. 19 Areas for further study include monitoring for changes in allergy clinic utilization and epinephrine autoinjector fill rates. This QI project model has potential for use in anaphylactic patients discharged in additional clinical settings.…”