Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter.
Br J Gen Pract. 2020 Dec 28;71(702):e55-e61. doi: 10.3399/bjgp20X713861. Print 2021 Jan.
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.
To investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence.
Cross-sectional analysis of QOF data for 7392 general practices in England.
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.
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.
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.
大多数患者通过处方从药店获得药物，但农村全科医生可以配药。这种药物配送方式的临床意义尚不清楚。本研究假设配药状态可能与更好的药物依从性有关。这可能会影响到一些依赖药物依从性的中间临床结果，例如高血压或糖尿病。
调查配药状态是否与依赖药物依从性的质量和结果框架（QOF）指标的实现差异有关。
对英格兰 7392 家全科医生的 QOF 数据进行横断面分析。
对英格兰 1000 名以上患者的全科医生的 QOF 数据（2016 年 4 月 1 日至 2017 年 3 月 31 日）与配药状态进行了链接，并对 QOF 指标进行了分类，根据其实现是否仅依赖于处方记录、药物依从性或两者兼而有之。使用混合效应逻辑回归对配药和非配药实践之间的差异进行了估计，调整了实践人群的年龄、性别、贫困程度、清单规模、单人执业状态和农村性。
共有 7392 家诊所的数据存在；其中 1014 家（13.7%）可以配药。在九个依赖于依从性的 QOF 指标中，有七个指标在配药实践中比在非配药实践中的实现情况更好，包括血压目标。在十个仅依赖于处方而不依赖于依从性的指标中，只有一个显示出更好的实现；与处方无关的指标显示出配药实践更高的实现趋势。
配药实践可能比处方实践实现更好的临床结果。需要进一步研究这些观察结果的潜在机制，并直接研究药物依从率。
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