Management of prescription refills in primary care: An Oklahoma Physicians Resource/Research Network (OKPRN) study

Background: Management of prescription refills is a significant challenge for primary care practices, but little information exists on the best way to do it. Methods: Using the "best practices research" method within a primary care practice-based research network, we delineated steps involved in the process and the most important requirements for each step. We identified potential exemplary practices for each step and conducted practice audits and patient surveys to document actual performance. Methods with the highest performance ratings for the predetermined requirements for the steps were combined into a "best" unified approach. Results: Half of the surveyed practices were satisfied with at least one step in their current refill management process, but only 9% ( 3 practices) were satisfied with all 5 steps. Practice audits identified acceptable methods for each step. The best combined method involves teaching patients to call the pharmacy first for prescription refills, accepting only fax requests from the pharmacy, allowing a nurse or medical assistant to make most refill decisions, documenting them in the chart immediately, responding back to the pharmacy by fax, and relying on the pharmacy to notify the patient when the refill is ready. Patient satisfaction with this method was reasonably good. The cost per refill was approximately $0.25 excluding overhead associated with office equipment and utilities. Conclusions: A satisfactory method for managing prescription refills in primary care practices was identified using the best practices research method.