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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR34

Repeat dispensing: the potential for improved drug utilisation and reduced costs

By C. M. Hughes, S. Varma, J. C McElnay, S. Mawhinney, D. C. MacAuley*, C. Fitzpatrick†, K. Turner† and A. McCollum†

Introduction In primary care, repeat prescribing is the most common way by which general practitioners (GPs) issue prescriptions to patients requiring chronic treatment. However, repeat dispensing, whereby a prescription is dispensed in parts rather than in total, may have the potential to decrease drug wastage, reduce National Health Service costs, improve medicines management and promote inter-professional liaison between general practice and community pharmacy.1,2
This pilot study sought to evaluate the economic, professional and patient impact of a repeat dispensing scheme.

Method Ten general medical practices and 43 pharmacies in close proximity were recruited from the four health and social services boards in Northern Ireland.
General medical practitioners (GPs) recruited patients who met pre-set criteria (community-dwelling, receiving long-term medication which had been relatively unchanged for six months prior to the study, exempt from payment charges and who regularly attended one of the participating pharmacies).
Patients were randomly assigned to either an intervention group (receiving a repeat dispensing prescription form covering six months, the medications to be dispensed in six instalments) or a control group (normal dispensing services). Recruitment occurred over a four-month period or until maximum target numbers were reached (n=200 per practice; 100 intervention, 100 control).
During the study period, the intervention patients were monitored by their pharmacists each month using a monitoring questionnaire and were given advice and counselled on their medication. A number of outcome measures were used to assess the impact of the service at six months, including compliance with drug regimens (using objective patient medication record [PMR] data and self-report), costs of drugs not dispensed and patient, pharmacist and GP satisfaction with the scheme.

Focal points

  • Repeat prescribing is the most common way prescriptions are issued to patients requiring chronic treatment
  • Repeat dispensing has been proposed as a mean to reduce drug wastage and costs and improve medicines' management
  • Ten GP practices, 43 community pharmacies and 1,607 patients participated in large pilot study in which intervention patients received their medication on a monthly basis for 6 months
  • Patients and health care professionals reported high levels of satisfaction with the new system, drug savings were demonstrated and patient compliance improved
  • This system of medication supply represents a way of improving patient care and promoting greater cohesion in the primary care team

Results A total of 1,607 patients (745 test; 862 control; mean age 60.4±18.4 years) were recruited into the study. Intervention patients were twice as likely to be compliant at six months compared with control patients, based on PMR data (odds ratio 2.12; 95 per cent CI 1.36-3.29). In addition, significantly fewer intervention patients reported non-compliance at the end of the six-month study period compared with control patients (p<0.05). The total cost savings from non-dispensed medicines in the intervention group was £46,553, which is approximately £10 per patient per month. Intervention patients rated the way in which their medicines were supplied and the prescription service much better than control patients (p<0.05). At least 70 per cent of all participating GPs and community pharmacists were positive in their assessment of the repeat dispensing scheme.

Discussion Other pilot work has reported that patients, pharmacists and GPs support a repeat dispensing service3 and this is borne out by the results from the present study. Greater patient compliance and reduced drug costs were also demonstrated.
Patients and health care professionals alike stated that they wished to see this system of dispensing becoming the norm. It is recognised that a number of practical issues (eg, prescription charges at each dispensing) and professional considerations (ie, increased workload and responsibility for pharmacists) have to be addressed before such a scheme can be rolled out into primary care. However, this system of medication supply represents a way of improving patient care and promoting greater cohesion in the primary care team.

Acknowledgement: This study was supported by the Research and Development Office, Department of Health and Social Services, Northern Ireland.

School of pharmacy, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL; *Institute of postgraduate medicine and health science, University of Ulster, Jordanstown, BT37 0QB; †Eastern health and social services board, Linenhall Street, Belfast

References

1. National Audit Office. Repeat prescribing by general medical practitioners in England. London: Stationery Office; 1993.
2. Royal Pharmaceutical Society and Department of Health. Pharmaceutical care: the future of community pharmacy. London: the Society and the Department; 1992.
3. Dowell J, Dodd T. Repeat dispensing by community pharmacists: a popular way to supplement treatment. Pharm J 1992; 255:R31.