E-drug: Dispensing Doctors Monitor article
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E-Druggers have discussed in the past the issue of dispensing
doctors and rational drug use. There are 78 messages in the E-Drug
archives.
But I would like to draw to your attention the brief article in the latest
Essential Drugs Monitor: "Dispensing prescribers - a threat to
appropriate medicines use?" Birna Trap, Ebba Holme Hansen. The
authors describe a comparative survey of prescribing by a group of
dispensing and a group of non-dispensing doctors in Harare,
Zimbabwe. The study identified major differences between the two
groups, with dispensing doctors prescribing significantly more
medicines, including antibiotics and injections, per patient than the
non-dispensing doctors.
To download the article using getweb send a message to
getweb@healthnet.org, leave the subject line blank and in the
message section write:
Begin
get http://www.who.int/medicines/mon/32_4.pdf
end
There is a longer article which is in Health Policy and Planning. The
url for this site is http://heapol.oupjournals.org/cgi/reprint/17/3/288.pdf
Getweb does not work as the site requires signing in but as I think
Health Policy and Planning is one of the journals that makes its
articles available in developing countries you may be able to
download the article. If you cannot and are particularly interested in
the topic please e-mail me and I will send you a copy.
I think that this is an important topic with serious policy implications.
The study looked at the many factors that could have been
associated with the dispensing doctors prescribing more drugs, more
injections more antibiotics and more mixtures. But at the end of the
day the authors concluded that being paid for dispensing affected
prescribing. This is consistent across all studies that I know of.
If this is the case, does it make sense to allow doctors to dispense if
there are pharmacies available to do the dispensing. If there are no
pharmacies available then should doctors be precluded from adding a
mark-up to the drugs and be limited to either charging cost price or at
most charging a fixed dispensing fee that does not change
irrespective of the numbers or cost of the drugs prescribed. If this is
not done the incentives are to the doctor to over prescribe.
The reverse issue also arises. What about prescribing dispensers?
Clearly pharmacists play an important role in advising about OTC
preparations but what happens when they "advise" on the purchase
of prescription medicines. I suspect that they will also be motivated by
potential profits to advise inappropriately.
My conclusion is that there are good reasons for the separation of
prescribing and dispensing functions. The challenge is to find
effective ways to enforce such a policy.
Richard Laing (Medical Officer)
Policy, Access and Rational Use
Essential Drugs and Medicines Policy
World Health Organization
CH-1211 Geneva 27, Switzerland
Tel 41 22 791 4533
Fax 41 22791 4167
E-mail laingr@who.int
Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml
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