Epinephrine autoinjector refill history in an HMO.
Epinephrine can be lifesaving in episodes of anaphylaxis, yet it is underprescribed and underused. Tracking of epinephrine refills over time for patients with a diagnosis of anaphylaxis has not been reported. This study reports on the refill history of 14,677 patients in a large HMO who received an initial dispensing of EpiPen (Dey Pharma, Basking Ridge, NJ) or EpiPen Jr between 2000 and 2006. A total of 6,776 (46%) refilled at least once. Twenty-five percent of the patients who were in the cohort for 5 years or more refilled multiple times, and 11% refilled consistently at all expected refill times. Infants through children 12 years of age were more likely to receive a refill dispensing (63%) compared with teenagers and adults (40%). The most common ICD-9 codes that were linked to the initial epinephrine dispensing were allergic disorder (37%), miscellaneous anaphylaxis/angioedema (23%), hymenoptera/insect bite or sting (14%), and specific or nonspecific food allergy (11%). A total of 79% of patients with a food-related ICD-9 code and 59% of patients with an insect sting-related ICD-9 code refilled epinephrine at least once. An opportunity exists to identify system-based as well as personal barriers in an ongoing effort to provide patients at risk with the tools and empowerment that could reduce their risk during life-threatening anaphylactic reactions.
Department of Allergy and Clinical Immunology, Kaiser Permanente, Los Angeles Medical Center, 1515 North Vermont, Los Angeles, CA 90046, USA. michael.s.kaplan@kp.org
Michael S
MS
Kaplan
Sandy Y
SY
Jung
Matthew L
ML
Chiang
D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006279:Health Maintenance Organizations; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D007267:Injections / Q000295:instrumentation / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D012189:Retrospective Studies; D012646:Self Administration / Q000295:instrumentation / Q000706:statistics & numerical data; D055815:Young Adult
D018926:Anti-Allergic Agents; D004837:Epinephrine