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Separation of prescribing and dispensing

October 15, 2023

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries it is traditional for physicians to also provide drugs.

Contemporary research indicates that separation of prescribing and dispensing lowers expenditure on drugs,[1][2] which is explained by the fact physician-prescribing gives doctors an incentive to over-prescribe. This is an example of a conflict of interest in the healthcare industry leading to unnecessary health care.

Background Edit

In many Western jurisdictions such as the United States, pharmacists are regulated separately from physicians. These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public, and that pharmacists cannot form business partnerships with physicians or give them "kickback" payments. In other words, the diagnosing physicians' role is supposed to extend only as far as providing proper prescriptions to patients, who are then entitled to purchase the prescribed drugs at the pharmacies of their choice.[3]

However, the American Medical Association (AMA) Code of Ethics provides that physicians may dispense drugs within their office practices as long as there is no patient exploitation and patients have the right to a written prescription that can be filled elsewhere.[4] 7 to 10 percent of American physicians practices reportedly dispense drugs on their own.[5]

In some rural areas in the United Kingdom, there are dispensing physicians[6] who are allowed to both prescribe and dispense prescription-only medicines to their patients from within their practices. The law requires that the GP practice be located in a designated rural area and that there is also a specified, minimum distance (currently 1 mile; 1.6 kilometres) between a patient's home and the nearest retail pharmacy. See Dispensing Doctors' Association.

This law also exists in Austria for general physicians if the nearest pharmacy is more than 4 kilometers (2+1⁄2 miles) away, or where none is registered in the city. Switzerland also allows dispensing physicians in several Kantons.[7]

 
One of a chain of pharmacies in Mexico City, Mexico, named "Doctor Discount," March 2010.

In other jurisdictions (particularly in Asian countries such as China, Malaysia, and Singapore), doctors are allowed to dispense drugs themselves and the practice of pharmacy is sometimes integrated with that of the physician, particularly in traditional Chinese medicine.

In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both enterprises to be common, but licensed separately.

The reason for the majority rule is the high risk of a conflict of interest and/or the avoidance of absolute powers. Otherwise, the physician has a financial self-interest in "diagnosing" as many conditions as possible, and in exaggerating their seriousness, because he or she can then sell more medications to the patient. Such self-interest directly conflicts with the patient's interest in obtaining cost-effective medication and avoiding the unnecessary use of medication that may have side-effects. This system reflects much similarity to the checks and balances system of the U.S. and many other governments.[citation needed]

A campaign for separation has begun in many countries and has already been successful (as in Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g. in Malaysia).[citation needed]

Experience in Asian countries Edit

In many Asian countries there is not a traditional separation between physician and pharmacist.[8] In Taiwan, a plan initiated in March 1997 experimented with separating doctors who prescribe from pharmacists who fulfill prescriptions on the theory that this would reduce unnecessary health care.[8] The plan had mixed results.[8] The South Korean government passed a law in 2000 which separated drug prescribing from dispensing.[9] The passing of the law achieved some of its intentions and also caused problems in unexpected ways.[9] Japan also is experimenting with separation of prescribing and dispensing. In Malaysia, as of 2016, separation of prescribing and dispensing only occurs in government hospitals.[10]

References Edit

  1. ^ Stacherl, Barbara; Renner, Anna-Theresa; Weber, Daniela (1 March 2023). "Financial incentives and antibiotic prescribing patterns: Evidence from dispensing physicians in a public healthcare system". Social Science & Medicine. 321. doi:10.1016/j.socscimed.2023.115791.
  2. ^ Müller, Tobias; Schmid, Christian; Gerfin, Michael (1 January 2023). "Rents for Pills: Financial incentives and physician behavior". Journal of Health Economics. 87: 102711. doi:10.1016/j.jhealeco.2022.102711. hdl:10419/264037.
  3. ^ Latham, Stephen R. (2001). "Conflict of Interest in Medical Practice". In Davis, Michael; Stark, Andrew (eds.). Conflict of Interest in the Professions. Oxford: Oxford University Press. pp. 279–301. ISBN 9780195344073. Retrieved 10 August 2020.
  4. ^ "Prescribing & Dispensing Drugs & Devices". American Medical Association.
  5. ^ American Association of State Compensation Insurance Funds, Prepackaged Drugs in Workers' Compensation
  6. ^ British Medical Association, briefing on dispensing doctors, 30 January 2009 [1][permanent dead link]
  7. ^ Der Hausarzt, Wirtschaftlich und patientenfreundlich - In der Schweiz geben Ärzte selbst Medikamente ab
  8. ^ a b c Chou, YJ; Yip, WC; Lee, CH; Huang, N; Sun, YP; Chang, HJ (September 2003). "Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience". Health Policy and Planning. 18 (3): 316–29. doi:10.1093/heapol/czg038. PMID 12917273.
  9. ^ a b Kwon, S (August 2003). "Pharmaceutical reform and physician strikes in Korea: separation of drug prescribing and dispensing". Social Science & Medicine. 57 (3): 529–38. doi:10.1016/s0277-9536(02)00378-7. PMID 12791494.
  10. ^ Tiong, JJ; Mai, CW; Gan, PW; Johnson, J; Mak, VS (August 2016). "Separation of prescribing and dispensing in Malaysia: the history and challenges". The International Journal of Pharmacy Practice. 24 (4): 302–5. doi:10.1111/ijpp.12244. PMID 26777986. S2CID 34885527.

Further reading Edit

Trap, B (1997). "Practices of dispensing doctors - drug use and health economics". archives.who.int. World Health Organization. Retrieved 14 February 2017.[dead link]

External links Edit

October 15, 2023
separation, prescribing, dispensing, also, called, dispensing, separation, practice, medicine, pharmacy, which, physician, provides, medical, prescription, independent, from, pharmacist, provides, prescription, drug, western, world, there, centuries, tradition. Separation of prescribing and dispensing also called dispensing separation is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug In the Western world there are centuries of tradition for separating pharmacists from physicians In Asian countries it is traditional for physicians to also provide drugs Contemporary research indicates that separation of prescribing and dispensing lowers expenditure on drugs 1 2 which is explained by the fact physician prescribing gives doctors an incentive to over prescribe This is an example of a conflict of interest in the healthcare industry leading to unnecessary health care Contents 1 Background 2 Experience in Asian countries 3 References 4 Further reading 5 External linksBackground EditIn many Western jurisdictions such as the United States pharmacists are regulated separately from physicians These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public and that pharmacists cannot form business partnerships with physicians or give them kickback payments In other words the diagnosing physicians role is supposed to extend only as far as providing proper prescriptions to patients who are then entitled to purchase the prescribed drugs at the pharmacies of their choice 3 However the American Medical Association AMA Code of Ethics provides that physicians may dispense drugs within their office practices as long as there is no patient exploitation and patients have the right to a written prescription that can be filled elsewhere 4 7 to 10 percent of American physicians practices reportedly dispense drugs on their own 5 In some rural areas in the United Kingdom there are dispensing physicians 6 who are allowed to both prescribe and dispense prescription only medicines to their patients from within their practices The law requires that the GP practice be located in a designated rural area and that there is also a specified minimum distance currently 1 mile 1 6 kilometres between a patient s home and the nearest retail pharmacy See Dispensing Doctors Association This law also exists in Austria for general physicians if the nearest pharmacy is more than 4 kilometers 2 1 2 miles away or where none is registered in the city Switzerland also allows dispensing physicians in several Kantons 7 nbsp One of a chain of pharmacies in Mexico City Mexico named Doctor Discount March 2010 In other jurisdictions particularly in Asian countries such as China Malaysia and Singapore doctors are allowed to dispense drugs themselves and the practice of pharmacy is sometimes integrated with that of the physician particularly in traditional Chinese medicine In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both enterprises to be common but licensed separately The reason for the majority rule is the high risk of a conflict of interest and or the avoidance of absolute powers Otherwise the physician has a financial self interest in diagnosing as many conditions as possible and in exaggerating their seriousness because he or she can then sell more medications to the patient Such self interest directly conflicts with the patient s interest in obtaining cost effective medication and avoiding the unnecessary use of medication that may have side effects This system reflects much similarity to the checks and balances system of the U S and many other governments citation needed A campaign for separation has begun in many countries and has already been successful as in Korea As many of the remaining nations move towards separation resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block e g in Malaysia citation needed Experience in Asian countries EditIn many Asian countries there is not a traditional separation between physician and pharmacist 8 In Taiwan a plan initiated in March 1997 experimented with separating doctors who prescribe from pharmacists who fulfill prescriptions on the theory that this would reduce unnecessary health care 8 The plan had mixed results 8 The South Korean government passed a law in 2000 which separated drug prescribing from dispensing 9 The passing of the law achieved some of its intentions and also caused problems in unexpected ways 9 Japan also is experimenting with separation of prescribing and dispensing In Malaysia as of 2016 update separation of prescribing and dispensing only occurs in government hospitals 10 References Edit Stacherl Barbara Renner Anna Theresa Weber Daniela 1 March 2023 Financial incentives and antibiotic prescribing patterns Evidence from dispensing physicians in a public healthcare system Social Science amp Medicine 321 doi 10 1016 j socscimed 2023 115791 Muller Tobias Schmid Christian Gerfin Michael 1 January 2023 Rents for Pills Financial incentives and physician behavior Journal of Health Economics 87 102711 doi 10 1016 j jhealeco 2022 102711 hdl 10419 264037 Latham Stephen R 2001 Conflict of Interest in Medical Practice In Davis Michael Stark Andrew eds Conflict of Interest in the Professions Oxford Oxford University Press pp 279 301 ISBN 9780195344073 Retrieved 10 August 2020 Prescribing amp Dispensing Drugs amp Devices American Medical Association American Association of State Compensation Insurance Funds Prepackaged Drugs in Workers Compensation British Medical Association briefing on dispensing doctors 30 January 2009 1 permanent dead link Der Hausarzt Wirtschaftlich und patientenfreundlich In der Schweiz geben Arzte selbst Medikamente ab a b c Chou YJ Yip WC Lee CH Huang N Sun YP Chang HJ September 2003 Impact of separating drug prescribing and dispensing on provider behaviour Taiwan s experience Health Policy and Planning 18 3 316 29 doi 10 1093 heapol czg038 PMID 12917273 a b Kwon S August 2003 Pharmaceutical reform and physician strikes in Korea separation of drug prescribing and dispensing Social Science amp Medicine 57 3 529 38 doi 10 1016 s0277 9536 02 00378 7 PMID 12791494 Tiong JJ Mai CW Gan PW Johnson J Mak VS August 2016 Separation of prescribing and dispensing in Malaysia the history and challenges The International Journal of Pharmacy Practice 24 4 302 5 doi 10 1111 ijpp 12244 PMID 26777986 S2CID 34885527 Further reading EditTrap B 1997 Practices of dispensing doctors drug use and health economics archives who int World Health Organization Retrieved 14 February 2017 dead link External links Edit nbsp Medicine portal nbsp Law portal Retrieved from https en wikipedia org w index php title Separation of prescribing and dispensing amp oldid 1170168236, wikipedia, wiki, book, books, library,

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