- Relapses or exacerbations of chronic conditions are often attributed to lack of medication or nonadherence.
- Barriers could be alleviated with access to a 24/7 pharmacy within emergency departments.
The AAP said adding around-the-clock pharmacies to hospital emergency departments in the United States could alleviate challenges to getting prescriptions filled immediately.
A technical report published in Pediatrics by the AAP’s Committee on Pediatric Emergency Medicine noted that families can be limited in their ability to have prescriptions filled immediately after an ED visit because of timing, lack of transportation, language barriers, issues with medical coverage and other reasons.
“Medical care provided in EDs often requires the treatment of acute clinical conditions, with a high priority placed on the timely administration of medications such as analgesics, antibiotics, bronchodilators, and corticosteroids,” they wrote. “Prompt initiation and maintenance of therapy are important factors in achieving an optimal therapeutic effect.” “Relapses or exacerbations of chronic conditions (eg, asthma, epilepsy, diabetes) are often attributable to lack of medication or nonadherence,” they continued. “Because emergency care is provided around the clock, inadequately available pharmacy services to dispense outpatient medications can be a significant therapeutic barrier.”
According to the authors, around one-third of patients do not obtain medications from an off-site pharmacy after being discharged from the ED. The authors cited a 2018 study that found that patients with access to a 24/7 retail pharmacy in an ED had a medicine adherence rate of 88.5%.
Among the benefits of around-the-clock pharmacies is the ability to identify people who cannot pay immediately, the authors said. A no-charge compassionate care provision may provide patients with the needed medications.
The authors noted other potential solutions, such as e-prescribing, which has been shown to reduce harm in pediatric care and decrease patient wait times but has not been shown to increase medication adherence. They also suggested administering a first antibiotic dose in the ED for patients who are able to take pills, which can be efficient in larger hospitals but not in smaller ones, and dispensing a few days’ supply of medication to a patient’s family, which can give a family more time to fill the prescription at a neighborhood pharmacy but works better for capsules instead of suspensions.
The authors did note some barriers to dispensing home medications in the ED, such as the burden of staffing a 24-hour outpatient pharmacy, insurance payments, economic advantages for hospitals over small community pharmacies and, most notably, regulations forbidding the practice in states like Massachusetts and Washington.
They also discussed some potential adverse effects of the practice, which could encourage visits to the ED rather than a pediatrician’s office, increase financial expenses for hospital pharmacies and slow EDs down.
“Dispensing important and necessary medications from the ED outpatient pharmacy in selected instances, if logistically, legally, and financially possible, allows medication to be provided more conveniently, reliably, and in a manner more proximate to the encounter,” they wrote. “This practice gives providers additional opportunities to reinforce medication instructions and their importance, including the use of materials for caregivers with low literacy, to ensure the family understands what they should do to safely administer medications to children once they get home.”