The Consequences of Requesting "Dispense as Written"
The Consequences of Requesting "Dispense as Written"
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DOI：
10.1016/j.amjmed.2010.11.020
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发表时间：
2011-04-01
影响因子：
5.9
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Shrank, William H.;Liberman, Joshua N.;Choudhry, Niteesh K.
背景：美国所有州都采用了通用替代法来降低药物成本。然而，医生可能会无视这些规定，开品牌药，并要求按照书面规定配药。病人也可以提出这些要求。很少知道的频率和相关的分配作为书面要求或他们与药物填充的关系。方法：我们确定了2009年1月从任何一家药店提交处方索赔的大型药房福利管理人员的受益人。我们将索赔分为医生指定的书面分配，患者指定的书面分配，或无书面分配。我们描述了这些请求的比率，并使用广义估计方程来评估与书面请求相关的医生、患者、治疗和药房特征。我们还使用广义估计方程来评估书面分配和处方不被患者填写率之间的关系。结果：我们的样本包括超过200万患者的560万张处方。超过2.7%被指定为医生书写的配药，2.0%被指定为患者书写的配药。根据药物类别、患者和医生年龄和地理区域，书面要求的分配存在实质性差异。专科医生要求书面处方的几率比全科医生高78.5% （P < 0.001）。当开始开慢性处方时，医生按处方开具处方（优势比1.50,P < .001）和患者按处方开具处方（优势比1.60,P < .001）与患者不按处方开具处方的几率较大相关。结论：按书面要求配药是常见的，并与处方填充率下降有关。减少按书面要求分发的比率的选择可能会降低成本并提高药物依从性。(C) 2011爱思唯尔公司版权所有。美国医学杂志（2011）124,309- 317
BACKGROUND: All US states have adopted generic substitution laws to reduce medication costs. However, physicians may override these regulations by prescribing branded drugs and requesting that they are dispensed as written. Patients also can make these requests. Little is known about the frequency and correlates of dispense as written requests or their association with medication filling.METHODS: We identified beneficiaries of a large pharmacy benefits manager who submitted a prescription claim from any pharmacy in January 2009. We categorized claims as a physician-assigned dispense as written, patient-assigned dispense as written, or no dispense as written. We described rates of these requests and used generalized estimating equations to evaluate physician, patient, treatment, and pharmacy characteristics associated with dispense as written requests. We also used generalized estimating equations to assess the relationship between dispense as written designation and rates prescriptions are not filled by patients.RESULTS: Our sample included 5.6 million prescriptions for more than 2 million patients. More than 2.7% were designated as dispense as written by physicians, and 2.0% were designated as dispense as written by patients. Substantial variation in dispense as written requests were seen by medication class, patient and physician age, and geographic region. The odds of requesting dispense as written was 78.5% greater for specialists than generalists (P < .001). When chronic prescriptions were initiated, physician dispense as written (odds ratio 1.50, P < .001) and patient dispense as written (odds ratio 1.60, P < .001) were associated with greater odds that patients did not fill the prescription.CONCLUSION: Dispense as written requests were common and associated with decreased rates of prescription filling. Options to reduce rates of dispense as written requests may reduce costs and improve medication adherence. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 309- 317