Abstract
IntroductionPatient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value.MethodsThis was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-sized Canadian city between April 1, 2014–June 30, 2017. Recorded outcomes included patient demographic data and access to a family doctor, medication requested, whether or not a prescription was given, and ED length of stay. Medication street value was determined using a local police service listing.ResultsA total of 2,265 prescriptions were requested by 1,495 patients. The patient median [interquartile range] age was 43 [32–54] years. A family doctor was documented by 55.4% (939/1,694) of patients. The two most commonly requested categories of medications were opioid analgesics 21.2% (481/2,265) and benzodiazepine anxiolytics 11.7% (266/2,265). Of patients requesting medication, 50.5% (755/1,495) requested medications without street value including some with potential to cause serious adverse health effects if discontinued. The requested prescription was received by 19.9% (298/1,495) of patients; 15.3% (173/1,134) returned for further prescription requests. The 90th percentile length of stay was 3.2 and 5.6 hours at the UCC and ED, respectively.ConclusionPatients who presented to the ED or UCC sought medications with and without street value in almost equal measure. A more robust understanding of these patients and their requests illustrates why a ‘one-size-fits-all’ response to these requests is inappropriate and signals some fault lines within our local healthcare system.
Highlights
Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department
INTRODUCTION they make up a small proportion of the overall visits,[1] patients presenting to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting a prescription pose many problems: 1) for the patient, who may experience a long wait and possibly a mismatch between what they want and what the acute care service is willing to provide; 2) for the physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misdirection of medications; and 3) for the department, which strives to conserve time and specialized resources that arguably should be directed toward patients with more urgent needs
Our study showed that approximately half of the patients presenting to an acute care department for the sole purpose of requesting a prescription asked for at least one medication that had value on the street
Summary
Research to date has offered some insight into two groups of vulnerable ED patients with a close relation to PRPs. The first group consists of heavy utilization patients who make multiple visits to the ED.[2] These patients have been shown to have unmet access needs and significant economic and social forces driving their choices.[3] The second group is patients who exhibit behaviors associated with prescription drug misuse.[4,5] This is a complicated group that intersects patients with pain and addiction issues.[6] Requesting a prescription refill is one behavior that has been identified with prescription drug misuse.[4,5] Patients in the ED who request prescriptions, make multiple visits, and exhibit prescription misuse behaviors are all subgroups of the very heterogeneous ‘non-urgent’ patient group for which a more robust literature exists.[7,8,9] use of the ED for any type of non-urgent care remains controversial. Whether or not these visits contribute to ED crowding, increased costs, and deprivation of continuity of care remains unresolved.[10,11,12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
