Cargando…

Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis

BACKGROUND: Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adher...

Descripción completa

Detalles Bibliográficos
Autores principales: Gomez-Cano, Mayam, Wiering, Bianca, Abel, Gary, Campbell, John L, Clark, Christopher E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716871/
https://www.ncbi.nlm.nih.gov/pubmed/33257460
http://dx.doi.org/10.3399/bjgp20X713861
_version_ 1783619243760156672
author Gomez-Cano, Mayam
Wiering, Bianca
Abel, Gary
Campbell, John L
Clark, Christopher E
author_facet Gomez-Cano, Mayam
Wiering, Bianca
Abel, Gary
Campbell, John L
Clark, Christopher E
author_sort Gomez-Cano, Mayam
collection PubMed
description BACKGROUND: Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. AIM: To investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence. DESIGN AND SETTING: Cross-sectional analysis of QOF data for 7392 general practices in England. METHOD: QOF data from 1 April 2016 to 31 March 2017 linked to dispensing status for general practices with list sizes ≥1000 in England were analysed. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. Differences were estimated between dispensing and non-dispensing practices using mixed-effects logistic regression, adjusting for practice population age, sex, deprivation, list size, single-handed status, and rurality. RESULTS: Data existed for 7392 practices; 1014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependent on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed better achievement; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. CONCLUSION: Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations and to directly study medication adherence rates.
format Online
Article
Text
id pubmed-7716871
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Royal College of General Practitioners
record_format MEDLINE/PubMed
spelling pubmed-77168712020-12-28 Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis Gomez-Cano, Mayam Wiering, Bianca Abel, Gary Campbell, John L Clark, Christopher E Br J Gen Pract Research BACKGROUND: Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. AIM: To investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence. DESIGN AND SETTING: Cross-sectional analysis of QOF data for 7392 general practices in England. METHOD: QOF data from 1 April 2016 to 31 March 2017 linked to dispensing status for general practices with list sizes ≥1000 in England were analysed. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. Differences were estimated between dispensing and non-dispensing practices using mixed-effects logistic regression, adjusting for practice population age, sex, deprivation, list size, single-handed status, and rurality. RESULTS: Data existed for 7392 practices; 1014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependent on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed better achievement; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. CONCLUSION: Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations and to directly study medication adherence rates. Royal College of General Practitioners 2020-12-01 /pmc/articles/PMC7716871/ /pubmed/33257460 http://dx.doi.org/10.3399/bjgp20X713861 Text en © The Authors http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
spellingShingle Research
Gomez-Cano, Mayam
Wiering, Bianca
Abel, Gary
Campbell, John L
Clark, Christopher E
Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title_full Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title_fullStr Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title_full_unstemmed Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title_short Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
title_sort medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716871/
https://www.ncbi.nlm.nih.gov/pubmed/33257460
http://dx.doi.org/10.3399/bjgp20X713861
work_keys_str_mv AT gomezcanomayam medicationadherenceandclinicaloutcomesindispensingandnondispensingpracticesacrosssectionalanalysis
AT wieringbianca medicationadherenceandclinicaloutcomesindispensingandnondispensingpracticesacrosssectionalanalysis
AT abelgary medicationadherenceandclinicaloutcomesindispensingandnondispensingpracticesacrosssectionalanalysis
AT campbelljohnl medicationadherenceandclinicaloutcomesindispensingandnondispensingpracticesacrosssectionalanalysis
AT clarkchristophere medicationadherenceandclinicaloutcomesindispensingandnondispensingpracticesacrosssectionalanalysis