title: Regional influences on the dispensing of glucose test strips in Dutch community pharmacies.
abstract: BACKGROUND
  Pharmacy practice guidelines promote the role of community pharmacies in self-monitoring of blood glucose. However, variations between Dutch pharmacies exist in the proportion of patients to whom test strips are dispensed.
  
  
  OBJECTIVE
  To assess whether variations between community pharmacies in dispensing of blood glucose test strips can be explained by differences in patient characteristics and the region in which the pharmacy is located.
  
  
  METHODS
  PHARMO-Record Linkage System containing drug dispensing histories from 40 community pharmacies of about 450,000 patients in the Netherlands.
  
  
  METHODS
  We performed a retrospective cohort study. Data on prescription of all drugs and medical aids between 1991 and 2001 were extracted for all new users of antidiabetic drugs. Patients were excluded if the dispensing history did not allow classification of the type of diabetes or if the dispensing pharmacy could not be determined. The data were analysed using a Cox proportional hazard model.
  
  
  METHODS
  Time to first test strips dispensed.
  
  
  RESULTS
  We identified 8,233 starters of antidiabetic drugs. During a median follow-up of 2.1 years, 20% of the patients were dispensed test strips at least once. Community pharmacy was significantly associated with the dispensing of test strips after adjustment for patient characteristics. This association was less apparent when stratified for the geographical location of the pharmacy.
  
  
  CONCLUSIONS
  Community pharmacy is an independent determinant of the start of use of test strips. Differences in dispensing of test strips between pharmacies are dependent on geographical region. This suggests that implementing practice guidelines for diabetes care in community pharmacy requires different approaches in different regions.
authors.affiliation: Department of Pharmacoepidemiology and pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Storimans
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Klungel
authors.forename: Herre
authors.initials: H
authors.lastname: Talsma
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: de Blaey
mesh_terms: D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring; D015331:Cohort Studies; D003157:Community Pharmacy Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011934:Reagent Strips; D012189:Retrospective Studies
chemical_list: D011934:Reagent Strips