Impact of maximum prescription length supply policy on patient medication adherence, health and economic outcomes

Abstract

In February 2016, Phramongkutklao hospital has implemented Extended Dispensing Policy (EDP), which increasing prescription length from 30-day to 90-day, with the purpose to increase adherence of patient to their medication prescribed. The objectives of this study were to determine the effects of the increasing in maximum prescription refill length from 30-day to 90-day on medication adherence, clinical outcomes such as HbA1c level and cholesterol level, economic outcomes including total healthcare costs, hospitalization costs, and total medication costs among diabetes and dyslipidemia patients in the Phramongkutklao hospital. This study is a quasi-experiment, pre-post, using a retrospective database from a hospital between 2014 to 2017. A difference-in-difference method with propensity score matching was applied to examine the change in medication adherence before and after the EDP implemented among the Universal Coverage insured patients. Multiple logistic and linear regression was performed to determine the association between predictors and interesting outcomes. For DM patients, the DID of MPR enhanced by 5% (P < 0.001). Likewise, the DID of dyslipidemia patients showed a significant increase of 4% (P < 0.001). In addition, the difference-in-difference of HbA1c in the intervention group over control group was lessened by 0.08% while reduction in cholesterol level by 2.83 mg/dL statistically significant (p < 0.001). Moreover, the results from regression revealed that for each 10% improvement in medication adherence was related with the significant reduction in HbA1c by 0.015% (p < 0.001), and cholesterol level by 1 mg/dl (p = 0.001). Furthermore, results from economic outcomes indicates that despite higher total medication costs, patients with greater medication adherence contributes significant saving due to reductions in time costs and hospitalization costs. There are several factors that affect medication adherence, particularly prescription length. Increasing prescription length from 30-day to 90-day, improved medication adherence, reduced in cholesterol and HbA1c level, and minimize total healthcare costs in dyslipidemia and type-2 diabetes patients.