Determining Adherence to Inhaled Corticosteroids From the Epic Electronic Medical Record.

Area of Science:

• Pulmonary Medicine
• Pharmacology

Background:

• Assessing patient adherence to inhaled corticosteroid (ICS) therapy is crucial for managing severe asthma.
• Pharmacy refill histories are commonly used to estimate ICS adherence.
• Electronic health record (EHR) systems like Epic may offer a convenient alternative for accessing refill data.

Purpose of the Study:

• To evaluate the accuracy of refill histories for inhaled corticosteroids (ICS) and ICS/long-acting beta-agonist (LABA) combinations as recorded in Epic's Medication Dispense History.
• To compare the accuracy of Epic's refill data against actual pharmacy refill records.

Main Methods:

• A retrospective review of 38 pediatric patients with severe asthma was conducted.
• Patients met specific criteria: same ICS product/dose for 6 months and available pharmacy data.
• Pharmacy refill records were verbally obtained and compared to Epic's dispensed medication history using a Wilcoxon matched-pairs signed-ranks test.

Main Results:

• Epic's initial refill data contained a 54% error rate due to duplicate entries.
• After duplicate removal, Epic's mean refill count (3.6) was slightly higher than pharmacy records (3.3) (p < 0.0001).
• Epic accurately reported total refills for 78.9% of patients; however, discrepancies in individual refill counts were noted.

Conclusions:

• The current version of Epic over-reports ICS refills, potentially hindering accurate adherence assessment.
• Absence of refills in Epic appears to be a reliable indicator of poor adherence.
• Clinical reliance on Epic's refill history for adherence monitoring requires careful consideration due to over-reporting tendencies.