“Fill ‘Er Up!” in the pharmacy of last resort: predictors of refill-seeking behavior in the emergency department

Study objectives: We determine predictors of medication refill-seeking behavior in emergency department (ED) patients with chronic illness. Methods: This was a prospective, cross-sectional ED survey of chronic medication use in a large public hospital ED (>140,000 visits/year) during a 6-week period. Adult ED patients (>18 years) taking chronic medications for congestive heart failure, diabetes mellitus, or hypertension were included. Results: Of 1,168 patients approached, none refused participation; 344 (29%) presented to the ED after running out of medications. Significant univariate predictors of “being in the ED for a medication refill” include age younger than 50 years, non-Hispanic ethnicity, low income (<$5,000/year), self-pay payer status, and being told to call a primary care provider (PCP) before medication would be refilled. Patients who did not know where the refill or pharmacy numbers were on their medication bottle were more than twice as likely to be in the ED for a medication refill (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.6 to 3.6; and OR 2.0, 95% CI 1.3 to 2.9, respectively). Conversely, patients who had refills listed on their medication bottles and those who had called the pharmacy for a refill in the past were only 33% and 25% as likely to be in the ED for a medication refill on the index visit (OR 0.31, 95% CI 0.2 to 0.49; and OR 0.24, 95% CI 0.16 to 0.34, respectively). When other demographic and clinical variables in a multivariate logistic regression model were controlled, there was a significant association between being in the ED for a medication refill and being uninsured, being ED reliant, being uninformed about refill numbers, being told to see a PCP for a refill, and having been admitted to the hospital in the previous 12 months (P<.01). Conclusion: Presenting for medication refills is common in ED patients with chronic illness; especially for those who are younger, uninsured, on a limited income, and unaware of common medication refill practices.