Impact of allowing pharmacists to independently renew prescriptions: A population-based study.

Objectives: To study the impact of a 2009 policy change in British Columbia (BC) that allowed pharmacists to independently renew certain prescriptions for chronic conditions. Design: Population-based analysis. Setting: BC, Canada. Participants: All residents of BC (more than 3.9 million). Intervention: Prescription drug use data were collected from the Pharma- Net database. This database contains a record of all ambulatory prescription drug dispensations in BC including a variable indicating whether a pharmacist renewed the prescription. Main outcome measures: We studied pharmaceutical and physician insurance claims datasets for all BC residents for 2 years following the 2009 policy change. We assessed the number and types of drugs renewed by pharmacists, and whether these complied with the policy. Further, we matched pharmacist-renewed prescriptions to equivalent potentially renewable prescriptions and assessed the impact on ambulatory physician visits. Michael R. Law, PhD, Canada Research Chair in Access to Medicines, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Lucy Cheng, MSc, Statistical Analyst, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Jillian Kratzer, MSc, Research Coordinator, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Steven G. Morgan, PhD, Professor, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Carlo Marra, PharmD, PhD, Professor and Dean, School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada Larry D. Lynd, PhD, Professor, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada Results: Over the first 2 years, pharmacists renewed 150,950 prescriptions in BC. Almost one-half of these renewals did not appear to match the conditions set out in the new regulatory policy (n = 69,970, 47%). Those that did match the conditions (n = 80,980,53%) represented a very small proportion of the 47 million prescriptions that pharmacists could have renewed (0.17%). The most frequently renewed medications were treatments for dyslipidemias, hypertension, diabetes, and gastroesophageal reflux disease. Pharmacist- renewed prescriptions were preceded by a 30% relative decrease in ambulatory physician visits in the week before dispensing, but there was also a 17% relative increase in visits in the week following the pharmacistrenewed prescription. Conclusion: Overall, the use of pharmacist renewals was very low and onehalf of the renewals were not policy-concordant. Pharmacist renewals were associated with the intended reductions in physician visits before dispensing, but there was also an unintended increase in visits after dispensing. These findings suggest that future policies such as this one need to be differently designed and closely monitored. [ABSTRACT FROM AUTHOR]