Physician Dispensing and Medication Non-Adherence: What Are the Facts?

What is Physician Dispensing?

Physician dispensing refers to the process whereby a doctor or other medical practitioner provides prescription medication directly to patients instead of writing them a prescription that they would then have filled out at a pharmacy.

Physician dispensing companies argue that this provides a major benefit in the fight against patient medication non-adherence (or non-compliance). How significant is this issue? Are doctors and clinics really in position to combat this problem by dispensing in-office?

Medication Non-Adherence

To be clear, medication non-adherence reflects a number of factors, such as premature termination of the course of treatment, non-compliance with the quantity and frequency prescribed. Not obtaining or filling the prescription is just one of these causes of non-adherence. With that in mind, let’s look at some of the research from the past 15 years:

  • The World Health Organization estimates that up to 50% of patients have poor medication compliance rates (including those who do never get their prescription filled).

  • The Annals of Internal Medicine studied over 10 million prescriptions from a network of 131 physicians encompassing 15,961 patients and found a 31.3% rate of non-obtention.

  • In 2005, the New England Journal of Medicine reported an approximately 20% primary non-adherence (non-obtention) rate, accounting for a large share of an overall 50% non-adherence rate.

  • A 2012 review of studies found that primary non-adherence rates were consistently 20-30% while overall non-compliance rates tended to be around 50%.

This data is remarkably consistent. Approximately 20-30% of prescriptions are never filled, accounting for about half of the overall non-adherence rate. This has major consequences for patients and the health care system as a whole, causing patients to suffer, and unnecessary hospitalizations and costs. As such, physician dispensing - which puts medication directly in the patient’s hands - can be a major factor in the fight against medication non-adherence.

That said, one cannot necessarily make the assumption that those patients who are not obtaining their prescriptions will comply with them if the problem of primary non-adherence is solved, so it would be stretching the point to argue that physician dispensing could solve half of the non-adherence problem. For example, patients who don’t pick up their prescriptions may also be the same type of patients who substitute their judgement for prescription instructions in ending treatment early, or their mental health or life situation might make compliance difficult. This has not be comprehensively studied.

Moreover, most physicians who dispense tend to dispense a small number of drugs, so even if every doctor dispensed, there would still be a role for pharmacies, and the problem of primary non-adherence would remain for all but the most commonly-prescribed medications.

In addition, there are potential downsides to in-office dispensing, including the possibility that patients will pay higher prices, that care may be distorted by economic incentives for doctors, and that abuse, errors, and negative interaction effects could multiply in an environment where a pharmacist’s “second look” no longer plays a role.

Conclusion

In conclusion, while proponents of physician dispensing can make a very plausible claim that in-office dispensing can be a major tool in the fight against medication non-compliance, this should not be over-stated and the in-office dispensing does not completely solve the problem or come close. In addition, these benefits must be examined in the context of the potentially negative side of physician dispensing.

Posted in Analysis on Jul 02, 2019

 

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