The rural dispensing practice – better medication adherence and clinical outcomes compared to non-dispensing practices? A cross-sectional analysis of routine data

Abstract

This is the author accepted manuscript. The final version is available on open access from the Royal College of General Practitioners via the DOI in this record.Background Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. Clinical implications of this difference in drug delivery are unknown. We 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 We investigated whether dispensing status is associated with differences in achievement of Quality and Outcome Framework (QOF) indicators that rely on medication adherence. Design and Setting Cross-sectional analysis of QOF data for 7,392 general practices in England. Method We analysed QOF data from 2016/17 linked to dispensing status for general practices with list sizes ≥1000 in England. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. We estimated differences 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 7,392 practices; 1,014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependant on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed evidence of a difference; 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.South West General Practice Trus