GPs should issue repeat prescriptions for longer than 28 days, study suggests

Patients with long-term conditions should be issued with prescriptions for longer than 28 days, according to new research.

Local guidance from many commissioners and the UK’s Pharmaceutical Services Negotiating Committee encourages GPs to issue shorter prescriptions, usually for 28 days in length, in a bid to reduce medication waste. However, a study published today in the British Journal of General Practice that was funded by the National Institute for Health Research found there was a lack of evidence to support this policy.

Researchers from RAND Europe in Cambridge conducted a systematic review of evidence dating back to 1993 that compared the impact of shorter (28 days) and longer (two to four months) prescriptions on clinical and health service outcomes.

All of the studies were randomised controlled trials in primary care settings in middle- and high-income countries that involved participants with relatively stable chronic conditions, including hypothyroidism, diabetes, cardiovascular disease and depression.

The researchers found nine studies that suggested longer prescriptions were associated with better medication adherence.

They also found six studies that suggested shorter prescriptions may be associated with less wastage, although these studies were considered to be ‘very low quality’.

The researchers concluded that recommendations to provide shorter prescriptions were 'not substantiated by the current evidence base'.

Longer prescriptions

The study's lead author Dr Sarah King, research fellow at RAND Europe, said: ‘Given our study results, CCGs and local NHS may wish to reconsider current recommendations for 28-day prescription lengths for patients with stable chronic conditions.’

Dr Rupert Payne, from the University of Bristol’s Centre for Academic Primary Care, one of the study’s authors said: 'This has been a contentious issue for many years. Our research shows that the current recommendations to issue shorter prescriptions have been based on a lack of sound scientific evidence. There is the potential for longer prescriptions to lead to important benefits, by improving patients’ adherence and thus the effectiveness of the drugs, lessening workload for health care professionals, and reducing inconvenience and costs to patients.'

However, he said that lengthening prescriptions would have implications for community pharmacy funding. 'Community pharmacies receive a fee for every prescription they dispense. So simply switching every repeat prescription item from, for example, one month to three months, could result in a large reduction in pharmacy income. Therefore, although the NHS may save money, it could lead to a loss of pharmacy services. Changes to policy around the length of repeat prescriptions should also consider how pharmacies are reimbursed.'

A study published in BMJ Open last December found that any savings due to reduced wastage resulting from issuing shorter prescriptions were more than offset by greater costs due to the additional work required by GPs and pharmacists.

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