Prescription refills for patients you haven't seen

[SmallBird]

I am hoping to get a sense of what people have experienced in their clinical settings regarding prescription refills, particularly in instances where a patient was seeing a provider who is no longer in the clinic, and they are asking you to do the refill until the patient can be seen by someone else. I have for the most part worked in clinics where I would just ask a patient like that to come in for an appointment, but I am hearing more from colleagues who describe refilling dozens of prescriptions to 'tide patients over' potentially for months when there is a backlog in access. What have folks seen and what is considered appropriate?

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[Bartelby]

If I am prescribing for someone for months, I would at least want to do a brief check in with them. That could even be a 5-minute conversation on the phone if they are stable, but I would want to have some minimum sense of how they are doing. If their provider has terminated care and you are prescribing for them for months, it seems to me that you are their new provider.

 

[Ironspy]

I have gotten these requests and sometimes when I look in the chart some of these patients have had their meds refilled by various providers without being seen for years. Others are clearly ok with this but I’m not.

If the new psychiatrist or NP has been hired with a start date I’ll just refill but if we are still looking and it’s been 6+ months since the patient has been seen I ask for a follow up with me and prescribe to that appt.

 

[calvnandhobbs68]

Yeah people do all kinds of things that are stupid. Once you send in prescriptions, you’re treating that patient and any halfway competent lawyer is gonna say you’re now liable for what happens.

I mean I’m by myself but the only way I’d do that is for actual coverage (like someone else is on vacation/leave but they’re coming back to cover their own patients at some point). Otherwise people would need to come see me. Not my fault they didn’t figure this out, very rarely do clinics not give people 30+ days notice about this kind of stuff. they can go see their PCP for a check in and refills if they need it in the meantime, but I’m not prescribing something if I don’t know you or haven’t eyeballed you. I would do it if they scheduled an appt with me in a reasonable time period (like 30ish days).

 

[Merovinge]

It's your DEA and medical license. Don't let any administrator or patient try to bully you into doing anything that is not safe medical practice. When in doubt go back to first principals. I actually don't even like the saying but First do no harm...

 

[comp1]

It totally depends on the meds and the patients. In general, if the meds look appropriate and particularly if they aren't DEA scheduled, I'll provide 30 days of meds and get an appointment scheduled within 30 days. That seems like a community standard. If your clinic cannot accommodate new (to you) patients within 30 days, stop working for that clinic.

 

[FlowRate]

Good documentation from prior doc, low risk meds/diagnoses/history, stable but can't repatriate to PCP because they are on a med that has to live in psych = fine to give them some flexibility (3-6 mo from their prior doc leaving.) And usually it's not as much us giving refills as much as it is their prior doc gave them 6 mo or a year of refills and now they need a refill so usually we'll get them in within 6 weeks at that point.

Poor documentation, high risk meds (or controlled subs)/diagnoses/history, unstable, etc. etc. of course see them much sooner.

 

[randomdoc1]

we should also not enable patients. they are responsible for being on top of their refills. We are very firm about this with patients here. We're not heavy handed but we do have reasonable boundaries. Since I see the whole patient cycle with reception, billing and provider visit, I KNOW for a fact that patients know precisely when their refills run out, that they need to be seen and have seen plenty of patients still try to get away with asking for refills. Many patients will call on their "last pill." This finding imho is clinically relevant. So while they were watching the pill bottle empty, why not call sooner knowing how far psychiatrists book out? In those cases with non-controls I too give 30 days and make the refill policy clear. I've even had patients lie and say "doctor ____ said i don't need to come in, I just get refills even if it's been over a year." I'm like no and no. I've also noticed patients not on top of their refills tend to be more complex often with personality features--especially the more recurrent and higher acuity the pattern is.

 

[comp1]

Absolutely, if this is a chronic issue with the patient, don't refill. The OP seems to describe more of a clinic issue (turnover) than an issue with the patient.

 

[randomdoc1]

months of backlog and refill requests to hold people over in the meantime sounds like a hot mess. Big clinic problem : /.

 

[painballer27]

I am hoping to get a sense of what people have experienced in their clinical settings regarding prescription refills, particularly in instances where a patient was seeing a provider who is no longer in the clinic, and they are asking you to do the refill until the patient can be seen by someone else. I have for the most part worked in clinics where I would just ask a patient like that to come in for an appointment, but I am hearing more from colleagues who describe refilling dozens of prescriptions to 'tide patients over' potentially for months when there is a backlog in access. What have folks seen and what is considered appropriate?

If they're not your patient and you're not seeing them then why refill their medication? Bring them in for a visit so you can do an assessment and bill for it