Abstract
BackgroundThe aim of this study was to estimate primary adherence for epinephrine autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada.MethodsA retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new EA prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of filling an EA prescription.ResultsOf 1212 EA prescriptions written between 2012 and 2014, only 69.9% (N = 847) were filled. An increased number of prescriptions for non-EA mediations was associated with an increased odds ratio of not filling an EA prescription.InterpretationThis is the first study in Canada to examine adherence for EA prescriptions. The non-adherence rate identified is higher than rates previously reported in the literature, and indicates that many EA prescriptions for adults seen in primary care may never be filled. It also suggests that prescriptions of EAs for all patients at risk of anaphylaxis in community settings should consistently be accompanied by concise information about the importance of having the EA prescription filled and having the EA readily available.
Highlights
There is international consensus that patients at risk for anaphylaxis in the community setting have an epinephrine autoinjector (EA) available at all times [1, 2]
Prescriptions written from April 1st, 2012 to December 31st, 2014 from the Manitoba Primary Care Research Network (MaPCReN) database were linked to Manitoba’s Drug Program Information Network (DPIN) data housed at the Manitoba Centre for Healthy Policy for medications that belong to the Anatomical Therapeutic Chemical (ATC) classification corresponding to an epinephrine autoinjector [7]
The number of non-EA prescriptions dispensed (6 or more non-EA dispensings, compared to 0–2 nonEA dispensings) was associated with an increased odds that an EA prescription would not be filled (OR = 2.24, 95% CI 1.44–3.47) in multivariate analysis
Summary
Introduction There is international consensus that patients at risk for anaphylaxis in the community setting have an epinephrine autoinjector (EA) available at all times [1, 2]. Epinephrine’s beneficial mechanisms of action include reduction in mast cell mediator release, vasoconstriction, inotropic and chronotropic effects and bronchodilation [1, 2] It can prevent and reduce symptoms and signs in all body organ systems involved in anaphylaxis (skin, upper and lower respiratory tract, gastrointestinal tract, and vasculature) [1, 2]. A survey of 1885 patients with a history of anaphylactic reactions noted that EAs were used in only 27% of these episodes [6]. Of those who didn’t use an EA, reasons included taking an H 1-antihistamine instead (38%) or having no EA prescription (28%). The aim of this study was to estimate primary adherence for epinephrine autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada
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