History is often said to repeat itself and time after time, we have experienced a repetition of seemingly past events. Dating as far back as 1271 in France, pharmacists and doctors were said to have had a feud over dispensing medications.
Prior to 1240 when the German Emperor Frederick II separated the roles of doctors and pharmacists, doctors were considered the best-placed profession to prescribe and dispense drugs. This centuries-long debate about who should legally dispense medications has continued till today in many developing and developed countries as well.
For most countries, there is usually a form of regulation for physician dispensing. In the USA for example, all 50 states have certain regulations that govern physician dispensing. 46 of these 50 states allow physicians to benefit from the profit of their practices – including dispensing pharmaceuticals.
The current form of physician dispensing began in 1982 when the FDA initiated regulations that approved of re-packaging drugs – thus allowing physicians in the United States to dispense drugs that have been packaged and labeled by a drug re-packager approved by the FDA.
These drug re-packagers, however, are expected to adhere to very stringent cGMP’s (Current Good Manufacturing Practices) regulated by the DEA and FDA. As a result of these regulations, the error rate of physician dispensing is much lower compared to pharmacy dispensing. These drugs are mostly unit packed with coherent labels and this reduces prescription and or dispensation errors.
Industry experts propose that there would be more and more physicians dispensing medications in the coming years because of a plethora of benefits the practice offers patients. Some of these benefits include;
- A significant reduction in unnecessary healthcare costs and deaths related to pharmacy errors
- Patients are more likely to comply and instead of having to inconvenience themselves with a trip to the pharmacy, they simply walk out of the doctor’s office with their medication.
- Safer and purer products for the patient
- The physician delivers the drug directly to the patient and this allows for a more direct translation of therapeutic intent.
Thanks to today’s current systems which allow physicians to effectively dispense medications to an accuracy within a short period of time, the erstwhile complicacies and time consumption of old have also been eliminated, thus providing better health care for patients.
However, physician dispensing creates room for a potential conflict of interest in a situation where the physician can profit from the pharmaceutical therapies. But as with other pre-existing lapses in other areas of medical practice, the chances that such conflicts of interests would arise are effectively checkmated by regulations, reviews, and transparency. There are systems in place to ensure that physicians provide therapies and diagnostic tests directly to the patient without extorting the patient in the process.
On the other hand, dispensing by pharmacists poses, even more, problems than just potential yet checkmated extortion. The increase in prescription load, as well as the leveling off of graduates from pharmacy school, is leading to a shortage of pharmacists. This by extension means drug stores are open for a reduced number of hours today, thus causing concerns about the dispensing errors that could be made by overworked pharmacists. Pharmacies are now increasingly placed within large retail centers with alcohol, snack foods and tobacco as stimuli. Pharmacy dispensing is also known to cause higher non-compliance and error rates.
According to a survey by American Association of Retired Persons (AARP), 21% of patients do not get their prescriptions filled at pharmacies, while another 30% of patients do not get their prescription drug refills from the pharmacies.
Patients who leave the physician’s office with their medication have a higher compliance to therapy rate (between 60%-70%). While one-third of all prescriptions are never filled thus stalling treatments and extending recovery time, a point of care or physician dispensing overcomes a huge portion of that noncompliance.
Finally, Pharmacists do not have special eyes. If you cannot see the doctor’s handwriting, chances are that the pharmacist cannot see it as well and this often leads to the pharmacist providing sound-alike drugs. Physician dispensing reduces the cost of prescription by as much as 50%, thus helping the health sector avoid the $100 billion cost per year of medical errors and noncompliance.