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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
More inWhite Papers  

a 28 days imageMarch 22 2018

Medicine adherence may benefit in long term conditions by issuing prescriptions for longer than 28 days.

Researchers have looked at the impact of longer duration prescribing, of between two and four months compared to the current 28-day standard. While there was “insufficient evidence relating to the overall impact of differing prescription lengths on clinical and health service outcomes,” the researchers concluded that “studies do suggest medication adherence may improve with longer prescriptions.”

In addition: “UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.”

The study was led by RAND Europe in Cambridge and funded by the National Institute for Health Research. It looked at studies published since 1993. Nine studies were found that suggested longer prescription frequency in long-term conditions did improve adherence, and six studies suggested that shorter prescription duration might be associated with reduced medicines wastage. However, these studies were considered to be of low quality.

A BMJ Open study from 2017 had also found that “any savings due to reduced waste resulting from issuing shorter prescriptions were more than offset by greater costs due to the additional work required by GPs and pharmacists,” said NIHR.

“Longer prescriptions could save GPs’ time, which could in turn be used to increase time spent with patients. Savings to the NHS from lengthening all prescriptions for statin drugs alone (one of the most commonly prescribed medications) were estimated at £62 million per year.”

One of the researchers of the new study, Dr Rupert Payne, from the University of Bristol’s Centre for Academic Primary Care, said that “the current recommendations to issue shorter prescriptions have been based on a lack of sound scientific evidence.”

However, he cautioned that lengthening prescriptions could have undesirable consequences for pharmacists.

“Community pharmacies receive a fee for every prescription they dispense. So simply switching every repeat prescription item from, for example, one month to three months, could result in a large reduction in pharmacy income. Therefore, although the NHS may save money, it could lead to a loss of pharmacy services. Changes to policy around the length of repeat prescriptions should also consider how pharmacies are reimbursed.”

Links:
NIHR 
S King et al. ‘Impact of issuing longer- versus shorter- duration prescriptions: a systematic review’. Br J Gen Pract 12 March 2018; bjgp18X695501           
B Doble et al. ‘Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK’. BMJ Open. 5 December 2017.     

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