Title: Patient Experience with Medication Refills Through Palliative Care Center

Authors: Ahsan Omer BS, Julissa Mireles BS, Shalini Dalal MD, Olga Fleckenstein BS, Mary Lou Warren DNP, Keyuri Popat MD

 

Introduction/Background:

Palliative care delivers alleviation of suffering for patients near end of life through effective pain management approach, including medication use. To enhance accessibility for patient inquiries and concerns outside regular hours, an after-hours call service is currently available. Patients consistently utilize this service beyond standard operating hours for urgent concerns. This study's purpose is to better understand palliative care cancer patients’ reasons for after-hours calls. In doing so, we aim to propose actionable modalities that address these underlying factors. The overall aim is to reduce the number of avoidable after-hours calls to decrease burden on patient and staff to improve patients’ experience.

 

Method:

This study is a retrospective analysis of nurse triage after-hours phone calls during September 2023-April 2024. From patient charts, all incoming calls and notes of after-hour service records were sorted for patients whose pain was managed by Palliative, Rehabilitation and Integrative Medicine (PRIM) department and subsequently analyzed. Data included after-hours call type, reason for visit/call, patient center, and category of call. This retrospective study was approved by Quality Improvement Assessment Board (QIAB). Descriptive statistics were used for analysis.

 

Results:

7475 after-hours calls were found during the months of September 2023-April 2024. Of these, the largest portion of after-hours calls were related to medication refill concerns, totaling 873 calls (11.7%). The PRIM department consisted of 89 total (10.2%) after-hours calls regarding medication refills. These were placed into 6 primary categories to identify the type of call. 39 (44%) calls attributed to running out of pain medications; 20 (22%) for out-of-stock (OOS) medication at the receiving pharmacy; 11 (12%) for patient education; 10 (11%) were associated with the script not being sent to the pharmacy; 4 (5%) were situations where pain was inadequately controlled; 4 (5%) calls required no intervention; and 1 (1%) was not accessible for patient privacy. The specific medications related to OOS concerns were identified (Figure 1). Of 20 calls, the primary medication for OOS concern was hydromorphone at 9 calls (45%), followed by morphine at 5 (25%), and oxycodone at 3 (15%). Only 1 call was recorded for the following: methadone (5%), oxycodone and acetaminophen (5%), and oxymorphone (5%).

 

Conclusions/Discussion:

The leading cause of after-hours calls related to medication refills is when patients are running out of their pain medications followed by pharmacy out-of-stock. These findings provide insight into areas of improvement regarding refills, which guide potential interventions to enhance patient experience. These include extending processing times by 4-5 days to provide more time, utilizing the MyChart® text messaging system for quicker issue resolution rather than phone calls, encouraging use of in-hospital pharmacy due to relatively more opioid availability, and ensuring that providers update patients' preferred pharmacies to streamline refill processes catered for the patients' needs.

In applying these changes, we aim to minimize the number of after-hour calls and decrease gaps in patient experience for better care. We look forward to these suggestions becoming implemented to record changes in delays that patients endure when refilling their medications to evaluate improvement in patients’ experience.