Epinephrine Autoinjector Refill History in an HMO

Abstract

Epinephrine can be lifesaving in episodes of anaphylaxis, yet it is underprescribed and underused. Tracking of epinephrine refills over time for patients with a diagnosis of anaphylaxis has not been reported. This study reports on the refill history of 14,677 patients in a large HMO who received an initial dispensing of EpiPen (Dey Pharma, Basking Ridge, NJ) or EpiPen Jr between 2000 and 2006. A total of 6,776 (46%) refilled at least once. Twenty-five percent of the patients who were in the cohort for 5 years or more refilled multiple times, and 11% refilled consistently at all expected refill times. Infants through children 12 years of age were more likely to receive a refill dispensing (63%) compared with teenagers and adults (40%). The most common ICD-9 codes that were linked to the initial epinephrine dispensing were allergic disorder (37%), miscellaneous anaphylaxis/angioedema (23%), hymenoptera/insect bite or sting (14%), and specific or nonspecific food allergy (11%). A total of 79% of patients with a food-related ICD-9 code and 59% of patients with an insect sting-related ICD-9 code refilled epinephrine at least once. An opportunity exists to identify system-based as well as personal barriers in an ongoing effort to provide patients at risk with the tools and empowerment that could reduce their risk during life-threatening anaphylactic reactions.

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

“…Beyond filling initial prescriptions, Kaplan et al . 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.…”

Epinephrine in anaphylaxis

“…Forty-six percent of patients refilled their injector at least once. Refills progressively decreased each year thereafter [23]. For the above reasons, epinephrine may not be given and education about anaphylaxis and avoidance of triggers is critical for patients and caregivers.…”

Anaphylaxis in Children: Current Understanding and Key Issues in Diagnosis and Treatment

“…School-aged children (aged ≥5 years) were less likely than younger children to have their EAI with them when eating lunch (25 % vs 42 %) or a snack (28 % vs 37 %) [37•]. In a recent study of 14,677 patients who filled an initial prescription for an EAI only 46 % ever refilled the prescription (63 % for children), and only 11 % refilled it at all the expected refill times [43]. It has been shown that parental empowerment and training on the use of an EAI significantly ( P  ≤ 0.05) correlates with greater parental comfort with administration [44], and EAI-training improves the odds of having an EAI readily available [37•].…”