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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Royal College of General Practitioners
2020
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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 |
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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 |
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