Pharmaceutical Research

Prohibiting physicians from dispensing drugs reduces overall drug use and inappropriate prescribing

Some industrialized nations, including many Asian countries, allow physicians to directly dispense drugs to patients. Yet in Korea, prohibiting physicians from dispensing drugs improved the quality of drug prescribing and decreased overall medication use. When Korean national policy prohibited doctors from dispensing drugs in 2000, it reduced overall drug prescribing, both of antibiotics and other drugs, and reduced inappropriate antibiotic prescribing for viral illness. Prior to that, the national health insurance system reimbursed doctors for dispensed drugs with predetermined prices. This allowed physicians to profit on the mark-up over drug purchase costs.

Forbidding Korean doctors to dispense drugs removed the potential profit incentive for drug prescribing, note the researchers. With partial support from the Agency for Healthcare Research and Quality (HS10391), they examined how many of 50,999 bacterial and viral illness episodes were prescribed an antibiotic and the total number of different antibiotics prescribed at 1,372 primary care clinics before and after the policy was implemented.

After the drug dispensing restriction, antibiotic prescribing declined substantially for patients with viral illness (from 80.8 to 72.8 percent of patients) and only minimally for patients with bacterial illness (from 91.6 to 89.7 percent of patients). The number of different antibiotics prescribed per episode also decreased significantly after the policy. The dispensing restriction also reduced prescribing of non-antibiotic drugs.

More details are in "Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians," by Sylvia Park, Ph.D., M.P.H., Stephen B. Soumerai, Sc.D., Alyce S. Adams, Ph.D., M.P.P., and others, in the September 2005 Health Policy and Planning 20(5), pp. 302-309.

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