Effect of prescription refill on quality of care among patients with type 2 diabetes: an exploratory study.
OBJECTIVE
Prescription refill might be effective in saving health expenditures, but whether a refilled prescription that reduces physician consultation affects quality of diabetes care is unknown. This study sought to examine the effect of prescription refill on the outcome quality of diabetes care.


METHODS
A quasi-experiment design with repeated HbA1c measures for the pretest and posttest periods for a total of 2 years was used. HbA1c functions as an outcome quality indicator. Prescription refill was measured dichotomously and also in times. Retrospective data of 1005 patients with type 2 diabetes were analyzed mainly by repeated measure General Linear Modeling at the multivariate level with difference-in-difference (DID) statistics.


RESULTS
Patients using prescription refills (n=779) experienced a significant decrease in HbA1c (from 8.4% to 7.8%, P<0.001), compared with those without refill (n=226, from 8.5% to 8.3%, P=0.171), with 0.3% of DID (P=0.043). Compared with non-refill peers, a greater percentage of patients refilling their prescriptions met the American Diabetes Association standards goal of (<7%/53 mmol/mol, P=0.037). Certain patients and physician characteristics were associated with the use of refills.


CONCLUSIONS
Clinically appropriate use of prescription refill would not result in a deterioration in glycemic control. On this basis, continuous refills may further benefit diabetic patients in treatment outcome and future cost. More attention is needed on the quality-effectiveness of prescription refill.
Department of Health Services Administration, China Medical University, Taiwan.
Jong-Yi
JY
Wang
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Shu-Hui
SH
Lee
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University, Taiwan.
I-Te
IT
Lee
National Changhua University of Education, Taiwan.
Jen-De
JD
Chen
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan. Electronic address: whhsheu@vghtc.gov.tw.
Wayne Huey-Herng
WH
Sheu
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
Diabetes; Glycemic control; Prescription refill; Quality of care; Treatment outcome