Physician-dispensing as a determinant of clinical and process measurements in patients at increased cardiovascular risk: A cross-sectional study in Swiss general practice. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Rachamin, Yael; Meier, Rahel; Valeri, Fabio; Rosemann, Thomas; Muheim, Leander
• Is Part Of: Health policy. Volume 125:Issue 10(2021)
• Page Start: 1305
• Page End: 1310
• Publication Date: 2021-10
• Subjects: Physician Dispensing -- Drug dispensing -- Medication dispensing -- General Practice Primary care -- Switzerland; HbA1c glycated hemoglobin -- sBP systolic blood pressure -- LDL-C low-density lipoprotein cholesterol -- CI confidence interval -- p p value; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2021.07.014
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: The drug-dispensing channel was not relevantly associated with the selected clinical measurements. The number of drugs per patient was similar for both drug-dispensing channels. Patients in the physician-dispensing group had higher annual consultation rates. Abstract: Aims: In some healthcare systems, physicians are allowed to dispense drugs; in others, drug-dispensing is restricted to pharmacists. Whether physician-dispensing affects patient health is unknown. Thus, we aimed to investigate associations between physician-dispensing and clinical and process measurements in patients with selected long-term conditions indicating increased cardiovascular risk. Methods: Retrospective cross-sectional study in 2018 based on data from electronic medical records of 22405 patients (73.6% physician-dispensing) in Switzerland with medications for diabetes mellitus, arterial hypertension, or lipid-related disorders. We used multilevel regression models to determine the associations between physician-dispensing and clinical measurements (glycated hemoglobin [HbA1c], systolic blood pressure [sBP], low-density lipoprotein cholesterol [LDL-C]) or process measurements (number of annual clinical measurements, consultations, and drug prescriptions). Results: Median (interquartile range) HbA1c value was 6.8% (6.3-7.5) both for the physician-dispensing and pharmacist-dispensing group, sBP was 137 (126-150) and 136 mmHg (126-149), and LDL-C was 2.3 (1.8-3.0) and 2.5 mmol/L (1.9-3.2). After adjustments, the physician-dispensing group had 4% lower LDL-C levels ( p = 0.041), 12% more frequent HbA1c measurements ( p = 0001), 16% higher annual consultation rates ( p < 0.05 for all conditions), and equal number of different drugs, compared to the pharmacist-dispensing group. Conclusions: We found no relevant differences in selected clinical measurements between physician- and pharmacist-dispensing, and mixed results in process measurements. Our results do not indicate that one drug-dispensing channel is superior to the other.