Abstract
This study investigates prescription filling for the treatment of sexually transmitted infections among adolescents in the emergency department setting.
Adolescents are disproportionately affected by sexually transmitted infections (STIs), making up nearly half of all diagnosed STIs annually,1 and are frequently diagnosed in the emergency department (ED) setting.2 Many STIs, such as gonorrhea and chlamydia, can be treated effectively with antibiotics. However, untreated, these infections can lead to serious morbidity. Although adolescents are often prescribed antibiotics to treat STIs, how often such prescriptions are actually filled by patients after ED discharge is unknown. We sought to fill this gap by investigating prescription filling for the treatment of STIs among adolescents in a real-world clinical setting.
Methods
This was a retrospective cohort study of visits made by adolescents aged 13 to 19 years to 2 pediatric EDs affiliated with Children’s National Medical Center, a large, urban, tertiary care children’s hospital. The study population included patient encounters associated with a diagnosis of pelvic inflammatory disease (PID) based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes or positive laboratory testing results of chlamydia infection for which patients were prescribed outpatient antimicrobial treatment between January 1, 2016, and December 31, 2017. The study was approved by the hospital’s institutional review board. Consent was not obtained owing to the retrospective nature of the study meeting minimal risk criteria.
The primary outcome was prescription filling of STI-related antimicrobial treatment. Secondary outcomes included patient-level and visit-level factors associated with prescription filling. Filling data were abstracted from SureScripts in our hospital’s electronic health record. SureScripts is a health information network that collects data about prescription filling from participating pharmacies and insurance plans. We used standard descriptive statistics to calculate the proportion of filled prescriptions and logistic regression to identify patient-level and visit-level factors associated with filling.
Results
During the study period, there were 696 ED visits with diagnosed STIs. Of these, 208 patients received outpatient prescriptions for antimicrobial treatment for cervicitis/urethritis (n = 65; 31.2%) or PID (n = 143; 68.8%) (Table). Of these prescriptions, 57.7% (95% CI, 50.9-64.5) were filled. In multivariable analysis, the only factor associated with prescription filling was hospital admission (73.7% vs 54.1%; adjusted odds ratio, 2.3; 95% CI, 1.0-5.0) (Table).
Table. Factors Associated With Prescription Filling.
| Variable | No. (%) | OR (95% CI) | aOR (95% CI) | |
|---|---|---|---|---|
| Total (N = 208) | Filled (n = 120) | |||
| Hospital admission | 38 (18.3) | 28 (73.7) | 2.37 (1.09-5.19) | 2.25 (1.02-4.99) |
| PID diagnosis | 143 (68.8) | 90 (62.9) | 1.98 (1.09-3.59) | NA |
| Age, mean (SD), y | 17.0 (1.4) | 17.0 (1.4) | 0.95 (0.77-1.15) | 0.95 (0.77-1.16) |
| Female | 193 (92.8) | 113 (58.5) | 0.62 (0.22-1.78) | NA |
| Race/ethnicity | ||||
| Non-Hispanic black | 175 (84.1) | 99 (56.6) | 1 [Reference] | 1 [Reference] |
| Hispanic | 28 (13.5) | 16 (57.1) | 1.02 (0.46-2.29) | 0.96 (0.42-2.20) |
| Other | 5 (2.4) | 5 (100.0) | NA | NA |
| Insurance status | ||||
| Private | 23 (11.1) | 16 (69.6) | 1 [Reference] | 1 [Reference] |
| Public | 170 (81.7) | 96 (56.5) | 0.57 (0.22-1.45) | 0.58 (0.22-1.53) |
| Uninsured | 15 (7.2) | 8 (53.3) | 0.50 (0.12-1.93) | 0.54 (0.14-2.16) |
Abbreviations: aOR, adjusted odds ratio; NA, not applicable; OR, odds ratio; PID, pelvic inflammatory disease.
Discussion
In this study, we found that less than 60% of prescriptions for the treatment of STIs among adolescents seeking care in the ED were filled. The prescription fill rate found in our study is similar to existing literature on rates of STI treatment adherence, which report rates between 25% and 73%.3,4 However, these studies used different methods to measure adherence and/or were conducted in controlled research environments in which participants were provided medications, offering little information about patient behavior in a real-world clinical setting such as our study. Given the astoundingly low rates of prescription filling for STI treatment, it is imperative that novel interventions to improve treatment adherence be explored.
Numerous factors have been associated with prescription filling and treatment adherence, including symptom severity5 and perceptions about the need for medications.6 These factors may be why we found higher rates of prescription filling among hospitalized patients. Admitted patients likely experience more severe symptoms and, thus, may have increased motivation to fill their prescriptions and achieve symptom relief. At our pediatric hospital, admission for PID treatment also prompts consultation with adolescent medicine specialists. Having in-depth conversations with such clinicians may influence patients to view antimicrobial therapy as necessary for improved health. Furthermore, adolescents admitted to the hospital may have more parental involvement than adolescents discharged from the ED, leading to additional support for prescription pickup and treatment initiation. Limitations of this study include the potential for limited generalizability because this study was conducted at a single-center ED and the potential for an overestimate of treatment adherence because prescription filling does not assure treatment completion.
Conclusions
The proportion of prescriptions filled for the treatment of STIs among adolescents diagnosed in the pediatric ED was low. Hospital admission was associated with prescription filling. Future studies should strive to understand the barriers underlying prescription filling to aid the development of targeted, ED-based interventions to promote STI-related treatment adherence.
References
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