Bellinger C, Foss P, Kotovicz F, Baumgardner D, Klink C, Klumph M, Kram J, De Grandville C. Medication refill protocol at a residency clinic. Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.
Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.
Background: In primary care clinics, prescription refill requests significantly impact day-to-day clinic workflow and can increase clinician burnout and patient dissatisfaction. Delays in response cause gaps in treatment leading to potential patient adverse events and stress on patient/provider relationships.
Purpose: To decrease the time to complete refill requests (refill approved or declined) and improve consistency in management of refills.
Methods: We created an interdisciplinary refill protocol based on state Medicaid preferred drug list data to allow for centralized, nursing-driven management of most prescription refills at a family medicine residency clinic in Milwaukee, Wisconsin. Medication refill processing time (from the time a refill encounter was open with a refill request to the time it was closed with refill approval or denial) was measured in minutes and was compared preprotocol (March 1, 2017, to November 30, 2017), during protocol adoption (December 1, 2017, to August 31, 2018), and postprotocol (September 1, 2018, to June 28, 2019). Mood median test was used to compare the average time for a medication refill request to be addressed. Levene’s test was used to test for equal variance surrounding the median of each group.
Results: Cohorts included preprotocol (n=24,073), protocol adoption (n=23,770), and postprotocol (n=25,770). We found a statistically significant reduction in median time to refill completion, from 232 minutes in the preprotocol phase to 157 minutes in the postprotocol phase (P<0.001). Reduction in median time to response was most apparent in the resident subgroup, with median times of 383 minutes preprotocol and 79 minutes postprotocol (P<0.001). There also were statistically significant reductions in variability of response time. Response time standard deviations (SD) had an overall reduction across groups (preprotocol mean SD: 14.5 days; during protocol adoption mean SD: 10.8 days; postprotocol mean SD: 6 days; P<0.0001).
Conclusion: This project reinforces the importance of a standardized multidisciplinary medication refill protocol to increase consistency and decrease medication refill time. Results from this project are being used to further improve and expand the process of medication refill within both of our academic family medicine clinics.