Management of Prescription Refills in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Article Figures & Data

Table 1.

Characteristics of the Five Audited Practices

Characteristic	Physician
Characteristic	A	B	C	D	E
Practice type	Small group^*	Solo	Small group^*	Solo	Residency faculty
Average number of patients seen per week	125	108	75	70	40
Payor mix: Medicare/Medicaid	30%	Not available	65%	25%	Not available
Commercial insurance	59%		35% combined	50%
Self-pay	11%		0%	25%
Scope of practice	No OB	No OB	No OB procedures	No OB	Full scope
Has an EMR	No	Yes	No	No	Yes
Geographic location	Suburbs	Rural	Rural	Rural	Urban
Size of town	>50,000–<100,000	<5,000	>5,000–<30,000	<5,000	>250,000
Pharmacies available	National chains	>2 locally owned	National chains	>2 locally owned	National chains
Steps for which practice satisfaction was high	3, 4, 5	1, 5	2	1, 2, 3, 4, 5	1, 3

Table 2.

Step 1: Patient Access to the System

Site^*	Percentage Calling Pharmacy First^†	Mean (SD) Patient Satisfaction with Method^‡	Percentage Reporting <2 Minutes for Initial Contact^§	Mean Practice Satisfaction
Clinic D^‖	33	4.3 (0.99)	60	4.0
Clinic B^‖	55	4.0 (1.3)	56	4.7
Clinic A	86	3.9 (0.95)	42	2.3
Clinic C	77	3.5 (1.1)	67	3.0
Clinic E^‖	88	3.2 (1.2)	50	4.0

* Table is ordered high to low based on patient satisfaction.
† χ² = 20.1, df = 4, P < .0001.
‡ F_4,128 = 3.5, P = .011; Newman-Keuls post hoc test revealed significant differences between clinics A and E (P = .03); B and E (P = .03); and D and E (P = .02).
§ χ² = 4.2, df = 4, P = .37.
‖ Self-reported practice satisfaction rates of 4.0 or higher.

Table 3.

Step 2: Communication with Pharmacies

Site^*	Method Used	Error Rate (%)^†	Mean Cost Per Refill for the Communication Step^‡	Mean Practice Satisfaction Level
Clinic D‖	FAX	0	$0.18	4.0
Clinic B^§	FAX/voice mail	2	$0.06	3.7
Clinic C‖	FAX	2	$0.13	4.0
Clinic A^§	FAX/phone	8	$0.17	2.3
Clinic E	FAX/phone	10	$0.33	3.3

Table 4.

Step 3: Decision-Making

Site^*	Decision-Maker	Written Protocol	EMR^†	Error Rate (%)^{^‡}	Mean Cost for Refill Decision	Mean Practice Satisfaction Level
Clinic A^§	MA	No	No	0	$0.10	4.7
Clinic C	MD	No	No	0	$0.21	2.5
Clinic D^§	MD	No	No	0	$0.82	5.0
Clinic B	LPN	Yes	Yes	4	$0.11	3.7
Clinic E^§	MA	Yes	Yes	10	$0.36	4.0

* Table is ordered low to high based on error rate.
† EMR, electronic medical record; MA, medical assistant; LPN, licensed practical nurse.
‡ χ² = 19.6, df = 4, P = .001.
§ Self-reported practice satisfaction rates of 4.0 or higher.

Table 5.

Step 4: Notification of Patients

Site^*	Percentage of Patients Reporting Less Than 8 Hours for Total Refill Time^†	Patient Satisfaction^‡	Mean Practice Satisfaction Level
Clinic D^§	88	3.9	5.0
Clinic B	70	3.9	3.3
Clinic A^§	76	3.6	4.0
Clinic C	61	3.6	3.0
Clinic E	31	3.0	3.3

Table 7.

Best Method for Each Step

Steps in the Prescription Refill Process	Best Method
Step 1. Patient access to the system	Patients should contact the pharmacy first when a refill is needed.
Step 2. Communication with the pharmacy	Communication should be by FAX and initiated by the pharmacy.
Step 3. Decision-making	Least costly method is to have nurse or medical assistant make decisions regarding refills. Training with the physician, including feedback regarding decisions will improve accuracy. Written protocols were associated with increased error rates.
Step 4. Notification of the patient	The pharmacy should notify the patient regarding the prescription refill decision.
Step 5. Documentation	Should be done by the decision-maker at the time of the decision. An EMR can make this more efficient.