GPs should write longer prescriptions for chronic conditions, researchers suggest

Medication adherence may improve when repeat prescriptions for long-term conditions are issued for 2-4 months rather than 28 days, a new study suggests.

UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base, a team of researchers has concluded.

Further information

BJGP study

The team, led by Dr Sarah King, research fellow at RAND Europe in Cambridge, report the findings in the British Journal of General Practice.

Searching the literature for randomised controlled trials and observational studies that examined longer prescriptions (2–4 months) compared with shorter prescriptions (28 days) in patients with stable, chronic conditions being treated in primary care, they identified 13 studies published between 1993 and 2015.

Nine of the studies suggested that longer duration prescriptions were associated with patients being more likely to take their medications.

Six studies suggested that shorter prescriptions might be associated with less wastage, although these studies were deemed to be very low quality.

'Currently, the UK Department of Health and Social Care advises that the frequency of repeat prescriptions should balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety but does not specify a recommended period,' said Dr King. 

'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.'

Cost savings

In related work already published in BMJ Open, the researchers analysed 11 years of UK GP prescribing data and found that any savings due to reduced waste resulting from issuing shorter prescriptions were more than offset by greater costs due to the additional work required by GPs and pharmacists. 

The team noted that the overall impact of differing prescription lengths on clinical and health service outcomes is uncertain.

Researcher Dr Rupert Payne, from the University of Bristol’s Centre for Academic Primary Care, also cautioned that lengthening prescriptions could have undesirable consequences for pharmacists.

'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.'

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