Assistant Professor CMSRU Camden, New Jersey, United States
Objectives: Medication refills can be a repetitive and time-intensive process for providers. Many medications, including vaginal estrogen, are refilled electronically by providers without a concurrent office visit. Integrated refill protocols are a clinical decision support (CDS) tool that lets providers quickly and safely determine the appropriateness of a refill request. CDS tools can improve effectiveness, user satisfaction, and efficacy when processing refill requests. We sought to develop a standardized, integrated CDS tool within our electronic health record (EHR) that would decrease errors in vaginal estrogen refills and decrease the burden of refill requests on providers.
Methods: Baseline data was collected from electronic vaginal estrogen refill requests between October 2022 through October 2023. A standardized, refill protocol was developed collaboratively between all providers in our office, encompassing parameters that providers manually review prior to refilling vaginal estrogen requests. These parameters were then integrated into our EHR and automatically appear when a vaginal estrogen refill request is sent to providers (Figure 1). The CDS tool was then implemented for our providers and then data was recollected after 6 months of implementation.
Results: Baseline data revealed that our providers received 396 electronic medication refills, 200 requests for vaginal estrogen (51%). Of the 167 vaginal estrogen refill requests that were approved, 24 (14%) had not been seen in the office in over 1 year. After further investigation of patients who had not been in the office in over 1 year, 7 (29%) had a diagnosis of postmenopausal bleeding in their chart and 1 (4%) had a diagnosis of endometrial cancer in their chart. Following implementation of an integrated CDS, only 9 (7%) patients of the 124 vaginal estrogen refill requests approved had not been seen in the office in more than 1 year. Of these patients, no patients had the diagnosis of postmenopausal bleeding, breast cancer, or endometrial cancer.
Conclusions: Utilization of an integrated CDS tool for the refill requests of vaginal estrogen may improve patient safety while simultaneously decreasing provider burden.
Figure 1: Example of refill protocol. Red “X” indicates failure of a parameter in the protocol, whereas green checkmark indicates passing of parameter.
