258. Frequency of Prescription Filling Among Adolescents Prescribed Treatment For STIs In The Emergency Department

Abstract

Adolescents are frequently diagnosed with sexually transmitted infections (STI) in the emergency department (ED). Untreated, STIs can lead to serious morbidity such as pelvic inflammatory disease (PID) and infertility. Although many patients are presumptively treated in the ED with single dose antibiotics, many are prescribed outpatient treatment. However, rates of prescription filling after discharge are unknown. This study sought to determine the frequency of filled prescriptions for adolescents prescribed antibiotics for outpatient management of STIs and identify factors associated with prescription filling. We performed a retrospective medical record review of all 2016-2017 pediatric ED visits made by adolescents aged 13-19 years who were prescribed antibiotics for the treatment of Chlamydia trachomatis (CT) cervicitis/urethritis or PID in Washington DC. We extracted data on outpatient prescription filling, patient demographics, and visit characteristics. We calculated the proportion of outpatient prescriptions filled, and performed multivariable logistic regression to identify patient- and visit-level factors associated with prescription filling. During the study period, there were 695 ED visits with diagnosed STIs, resulting in 207 outpatient prescriptions for CT urethritis/cervicitis (n=64) or PID (n=143) treatment. The mean age of the study sample was 17.1 (+/- SD 1.4) years, and the majority was female (92.8%), of non-Hispanic black race/ethnicity (84.1%), and publicly insured (81.6%). Nearly 18% of patients were admitted for inpatient management of PID. The overall prescription fill rate was 58.0% (95% CI 51.2, 64.8) [CT urethritis/cervicitis (46.9%; 95% CI 34.4, 59.3) and PID (62.9%; 95% CI 54.9, 70.9)]. After adjusting for age, race/ethnicity, and insurance status, prescription filling was associated with hospital admission (aOR 2.5; 95% CI 1.1, 5.7) compared to ED discharge and PID diagnosis compared to CT cervicitis/urethritis (aOR 2.0, 95% 1.1, 3.9). Overall, adolescents evaluated in two pediatric EDs had low rates of filling outpatient prescriptions for treatment of STIs, placing them at risk for increased morbidity and complications from untreated STIs, as well as further transmission of infection. Patients who were diagnosed with PID and those who were admitted to the hospital were more likely to fill their prescriptions. Future studies should focus on understanding barriers to prescription filling to inform interventions for improvement in treatment adherence.