title: The effect of prescription size on acquisition of maintenance medications.
abstract: OBJECTIVE
  To determine whether large prescriptions (> or = 90 days' supplies) enhance the acquisition of maintenance medications by patients.
  
  
  METHODS
  Study 1: multisite, retrospective cohort study evaluating outpatient digoxin use. Study 2: single-site, retrospective cohort study to confirm Study 1.
  
  
  METHODS
  Study 1: Ten Veterans Affairs Medical Centers in the Rocky Mountain region. Study 2: The only facility from Study 1 (site C) that dispensed large prescriptions of maintenance medications.
  
  
  METHODS
  Randomly selected outpatients receiving two or more digoxin prescriptions (n = 176 in Study 1, n = 114 in Study 2).
  
  
  METHODS
  None.
  
  
  RESULTS
  The main outcome measure was the proportion of prescribed doses of maintenance medications obtained. In Study 1, patients who received at least one large digoxin prescription obtained a mean of 137.2% of their prescribed digoxin doses over a mean of nine months, compared with 91.3% for patients who received only small prescriptions of < 90 days' supplies (p = 0.02). Patients receiving large prescriptions were more likely to obtain at least 100% of their prescribed amounts of digoxin (adjusted OR = 11.4, 95% CI = 1.3-96.8, p = 0.03). At site C, patients in Study 1 obtained a mean of 129.0% of all maintenance drugs given in large supplies, compared with 95.2% of drugs prescribed only in small supplies (p = 0.006). In Study 2, acquisition of digoxin increased progressively from 89.7% among individuals who received only small digoxin prescriptions to 113.0% for those who received only large supplies (p = 0.002), over a mean of 14 months.
  
  
  CONCLUSIONS
  Large prescriptions facilitate the acquisition of maintenance medications but may lead to oversupplies, while small prescriptions impose a barrier to obtaining these drugs.
authors.affiliation: Denver Department of Veterans Affairs Medical Center, Colorado.
authors.forename: J F
authors.initials: JF
authors.lastname: Steiner
authors.forename: L J
authors.initials: LJ
authors.lastname: Robbins
authors.forename: S C
authors.initials: SC
authors.lastname: Roth
authors.forename: W S
authors.initials: WS
authors.lastname: Hammond
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy; D015331:Cohort Studies; D004077:Digoxin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States
chemical_list: D004077:Digoxin