The Effect of Physician Dispensing on Visit Compliance and Blood Pressure Control in a Rural Family Practice Clinic

Abstract

: Physician dispensing of drugs is making a comeback in the United States. Critics charge that physician dispensing for profit represents a conflict of interest and removes the normal checks and balances that exist when a physician writes a prescription later filled by a pharmacist. Proponents justify dispensing because it is more convenient for patients, because it assures that patients will receive the brand name ordered, and because it improves compliance. This retrospective chart review examines visit compliance and blood pressure control in a cohort of treated hypertensive adults attending a family practice clinic where patients were given the choice of either physician-dispensed drugs or prescriptions. Over an 18 month period 61 of 77 patients (79%) in the dispensed group met criteria for visit compliance, compared with 22 of 45 patients (49%) in the prescription group (P<0.001, chi-square). Sixty-five of 77 patients (84%) in the dispensed group achieved adequate blood pressure control as did 36 of 45 patients (80%) in the prescription group. Patients were equally distributed between the dispensed and the prescription groups with respect to age, sex, and antihypertensive regimen. The study implies that physician dispensing improves one measure of patient compliance but that the improvement in compliance may not necessarily improve outcome. This discrepancy between compliance and outcome is not an unusual finding in the compliance literature. Prospective studies are needed to elucidate the effect of dispensing on patient satisfaction, patient care, and medical costs.