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Do doctors in dispensing practices with a financial conflict of interest prescribe more expensive drugs? A cross-sectional analysis of English primary care prescribing data
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  • Published on:
    Dispensing doctors
    • Darrin Baines, Professor of Health Economics Bournemouth University

    Prescribing in dispensing practices: A response to Goldacre et. al.

    Goldacre et. al. is a welcome contribution to the ongoing debate about the causes of high cost prescribing by primary care doctors in the NHS.[1] Their paper claims that doctors in “dispensing” practices (that is, rural practices with an dispensary) have a potential financial conflict of interest around their prescribing decisions because they have the opportunity to earn additional revenues by using more expensive medicines. Using the NHS England Primary Care Prescribing dataset for January 2015 only, they examine data on statins, proton pump inhibitors (PPIs), ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs). These are the four most commonly prescribed classes of drugs where there is clear guidance that higher cost items are no more effective than lower cost products. Within each of these four classes, they identified options with high acquisition costs that are considered to be as effective as those with lower costs. Following statistical analysis, the authors found that dispensing practices are significantly more likely to prescribe drugs from this list of higher cost products across all four categories.

    Response
    Following a gap in published research on this topic of over twenty years, Goldacre et. al. have been successful in raising again the issue of whether NHS dispensing doctors are more expensive. Although their results seem conclusive, on methodological grounds,...

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    Conflict of Interest:
    None declared.
  • Published on:
    Australian case study
    • David Lim, senior lecturer Flinders University Rural and Remote Health

    Whilst a systematic review of dispensing doctors found increased prescription and less often in generics [Health Policy. 2009 Sep;92(1):1-9] and concurred with findings from this study, the Australian census data on its dispensing doctors reportedly contradict the international trends [Med J Aust. 2011 Aug 15;195(4):172-5]. In Australia, doctors are only allowed to dispense under its National Health Act where there is no convenient and efficiency access to pharmacists. Community pharmacy owners in Australia are largely represented by the Pharmacy Guild of Australia which is a major lobbyist and advocate with the Australian Government, see for instance the successive Community Pharmacy Agreement. There are other factors identified in the mixed methods study which may explain the better quality of prescribing in Australia as compared to the English findings. Is there cross-jurisdictional lesson to be learned?

    Conflict of Interest:
    Author of the two papers referenced in the comments. I have not received any financial contribution or obtained other profit or personal gain from drug companies, Pharmacy Guild of Australia or the dispensing doctors.