Abstract
Background
Long-term conditions place a substantial burden on primary care services, with drug therapy a core aspect of clinical management. The ideal frequency for issuing of repeat prescriptions for these medications is unknown.
Aim
To examine the impact of longer duration versus shorter (28-day) duration prescriptions.
Design and Setting
Systematic review of primary care studies (PROSPERO: CRD42015027042)
Method
Scientific and grey literature databases were searched from inception up to 21/10/2015. Eligible studies were randomised controlled trials (RCTs) and observational studies that assessed longer prescriptions (range 2 to 4 months) compared with shorter prescriptions (around 28 days), in patients with stable, chronic conditions being treated in primary care. Outcomes of interest were: health outcomes, adverse events, medication adherence, medication wastage, professional administration time, pharmacists’ time/costs, patient experience, and patient out-of-pocket costs.
Results
Moderate quality evidence from nine studies suggested that longer prescriptions are associated with increased medication adherence. Evidence from six studies suggested longer prescriptions may increase medication waste, but results were not always statistically significant and were of very low quality. No eligible studies were identified that measured any of the other outcomes of interest, including health outcomes and adverse events.
Conclusion
There is insufficient evidence for the overall impact of differing prescription lengths on clinical and health service outcomes, although studies do suggest adherence may improve with longer prescriptions. Current UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.
How this fits in
Local guidance from many health service commissioners, as well as the UK’s Pharmaceutical Services Negotiating Committee, encourages general practitioners (GPs) to issue shorter prescriptions, typically 28 days in length. This guidance is based on non-systematic review evidence, which was not substantiated by our systematic review. Longer prescriptions lengths for people with stable, chronic conditions could be potentially important to GPs in terms of reducing their workload. It also has the potential to have a positive impact for patients, including improving adherence and thus medication effectiveness, and reducing time, cost and inconvenience.
Long-term conditions place a substantial burden on primary care services, with drug therapy a core aspect of clinical management. The ideal frequency for issuing of repeat prescriptions for these medications is unknown.
Aim
To examine the impact of longer duration versus shorter (28-day) duration prescriptions.
Design and Setting
Systematic review of primary care studies (PROSPERO: CRD42015027042)
Method
Scientific and grey literature databases were searched from inception up to 21/10/2015. Eligible studies were randomised controlled trials (RCTs) and observational studies that assessed longer prescriptions (range 2 to 4 months) compared with shorter prescriptions (around 28 days), in patients with stable, chronic conditions being treated in primary care. Outcomes of interest were: health outcomes, adverse events, medication adherence, medication wastage, professional administration time, pharmacists’ time/costs, patient experience, and patient out-of-pocket costs.
Results
Moderate quality evidence from nine studies suggested that longer prescriptions are associated with increased medication adherence. Evidence from six studies suggested longer prescriptions may increase medication waste, but results were not always statistically significant and were of very low quality. No eligible studies were identified that measured any of the other outcomes of interest, including health outcomes and adverse events.
Conclusion
There is insufficient evidence for the overall impact of differing prescription lengths on clinical and health service outcomes, although studies do suggest adherence may improve with longer prescriptions. Current UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.
How this fits in
Local guidance from many health service commissioners, as well as the UK’s Pharmaceutical Services Negotiating Committee, encourages general practitioners (GPs) to issue shorter prescriptions, typically 28 days in length. This guidance is based on non-systematic review evidence, which was not substantiated by our systematic review. Longer prescriptions lengths for people with stable, chronic conditions could be potentially important to GPs in terms of reducing their workload. It also has the potential to have a positive impact for patients, including improving adherence and thus medication effectiveness, and reducing time, cost and inconvenience.
| Original language | English |
|---|---|
| Pages (from-to) | e286-e292 |
| Number of pages | 7 |
| Journal | British Journal of General Practice |
| Volume | 68 |
| Issue number | 669 |
| Early online date | 28 Mar 2018 |
| DOIs | |
| Publication status | Published - Apr 2018 |
Keywords
- Prescription length
- Primary care
- Repeat prescribing
- Medication adherence
- Medication waste