Limitations
This study has several important limitations. Most importantly, this was
a retrospective cohort, reliant on the EMR and e-prescribing records to
obtain information. This resulted in a large number of excluded patient
visits for which we could not determine prescription filling. In
addition, patients in whom we could not determine EAI filling were
slightly more likely to have out-of-state Medicaid or self-pay insurance
and slightly more likely to be Hispanic. It’s possible that this patient
demographic is less likely to use e-prescribing or less likely to use
pharmacies participating inSureScripts. This could create a selection
bias with a trend towards a lower reported EAI fill rate as this patient
demographic is somewhat more likely to fill EAI prescriptions. However,
the overall number of these patients was small compared to the larger
population. We were also unable to determine if patients already had
EAIs at home or if they had, previously or after the ED visit, received
a prescription from their primary care physician or another health care
provider that they may have filled. In addition, we were only able to
collect a limited amount of data from the EMR and therefore have no
first-hand knowledge as to the barriers to EAI filling. Finally, the
unique definition of Washington, DC as an urban district that lies
outside of any state, lends itself to creating variables that might not
be generalizable to the greater population.
In conclusion, in this cohort of pediatric patients prescribed an EAI on
ED discharge from the pediatric ED, only approximately half of the
patients filled their EAI prescriptions. Further studies examining
predictors of EAI filling are needed to develop patient and
system-oriented strategies to improve prescription filling.
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