Bradley F, Elvey R, Ashcroft D M, Noyce P
Centre for Innovation in Practice, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK.
J Clin Pharm Ther. 2007 Jun;32(3):269-75. doi: 10.1111/j.1365-2710.2007.00821.x.
Repeat dispensing by community pharmacists has now been rolled out nationally within England in order to improve patient convenience and reduce doctors' workload. Little is known about how the charge status of the patient may impact on the uptake and prescribing practices of this service.
To examine whether the charge status of the patient influences the length of the repeat prescribing cycle.
Thirty-six community pharmacies collected data on repeatable prescriptions dispensed over a 4-month period. A purposive sample of 13 general practices actively involved as pathfinder sites were selected for interview, to explore views on repeat prescriptions and influence of prescription charges.
Completed audit forms were collected on 4029 repeatable prescriptions. Differences in the length of the prescribing interval between charge payers and exempt patients were found to be statistically significant (Mann-Whitney U-test, P < 0.001), indicating that prescribers were issuing prescriptions for longer interval periods for charge payers. Thirteen general practitioners (GPs) and three practice managers were interviewed across 13 practices. Some GPs varied their prescribing to minimize the cost to patients. Others were motivated to reduce waste and promoted 28-day prescribing for all patients.
The study has shown that charge paying patients are more likely to have longer prescribing intervals and that cost to the patient is a consideration for GPs when making these decisions. Future work should explore the influence of other factors such as age, socio-economic status and patient morbidity on prescribing in primary care.
为了提高患者的便利性并减轻医生的工作量，社区药剂师的重复配药服务现已在英格兰全国范围内推行。关于患者的收费状态如何影响这项服务的使用情况和处方开具做法，目前所知甚少。
研究患者的收费状态是否会影响重复处方周期的时长。
36家社区药房收集了4个月内发放的可重复处方的数据。选取了13家作为试点积极参与的全科诊所进行有目的抽样访谈，以探讨对重复处方的看法以及处方收费的影响。
共收集到4029份可重复处方的完整审核表。发现付费患者和豁免患者的处方间隔时长存在统计学显著差异（曼-惠特尼U检验，P < 0.001），这表明开处方者为付费患者开具的处方间隔期更长。对13家诊所的13名全科医生（GP）和3名诊所经理进行了访谈。一些全科医生调整了他们的处方开具方式，以尽量减少患者的费用。另一些人则致力于减少浪费，并推广为所有患者开具28天的处方。
该研究表明，付费患者更有可能有更长的处方间隔期，并且患者费用是全科医生做出这些决定时考虑的一个因素。未来的工作应探讨年龄、社会经济地位和患者发病率等其他因素对基层医疗处方开具的影响。
