A comparison of chronic medicine prescribing patterns between mail order and community pharmacies in South Africa
Coetsee, Janine Mari
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Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation.
- Health Sciences