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Dispensing practices issue shorter prescription lengths compared with non-dispensing practices: a quasi-experimental
Ian Holdroyd1, Liam Loftus2, Cameron Appel2
1Wolfson Institute of Population Health, Queen Mary University of London, London, UK ijh34@cantab.ac.uk.
Background:
Dispensing practices, which have in-house dispensaries, are paid to dispense medications directly to patients. Evidence suggests that this financial incentive influences prescribing behaviour, although the underlying mechanisms remain unclear.
Aim:
To investigate the impact of dispensing status on prescription length in England.
Design & Setting:
Quasi-experimental, repeated-measures, cross-sectional study of English general practices.
Method:
Business administration data classified practices as dispensing or non-dispensing, determined the percentage of patients eligible for dispensing, and captured prescription lengths for seven drugs with fixed dosing regimens at 3-month intervals from July 2023 to April 2024. Generalised estimating equations analysed the relationship between dispensing status and the proportion of patients eligible for dispensing with average prescription length, controlling for patient and practice characteristics.
Results:
Adjusting for patient and practice characteristics, dispensing practices prescribed shorter average lengths for all drugs. Desogestrel showed the largest difference (21.9 days shorter), followed by indapamide standard release (9.85 days), indapamide modified release (9.71 days), ezetimibe (8.41 days), tamsulosin (7.18 days), alendronic acid (6.63 days), and dapagliflozin (5.85 days). An increase in the proportion of patients eligible for dispensing was associated with significantly shorter prescription lengths across all drugs. Dispensing practices more consistently prescribed medications for 28-31 days, whereas non-dispensing practices showed greater variability.
Conclusion:
Dispensing practices are associated with shorter prescription lengths, increasing the number of prescriptions issued over time and the associated dispensing fee. The absence of clear guidance on prescription lengths likely contributes to this variability. Central bodies should consider providing explicit recommendations to optimise prescription durations.
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