title: Impact of allowing pharmacists to independently renew prescriptions: A population-based study.
abstract: OBJECTIVE
  To study the impact of a 2009 policy change in British Columbia (BC) that allowed pharmacists to independently renew certain prescriptions for chronic conditions.
  
  
  METHODS
  Population-based analysis.
  
  
  METHODS
  BC, Canada.
  
  
  METHODS
  All residents of BC (more than 3.9 million).
  
  
  METHODS
  Prescription drug use data were collected from the PharmaNet database. This database contains a record of all ambulatory prescription drug dispensations in BC including a variable indicating whether a pharmacist renewed the prescription.
  
  
  METHODS
  We studied pharmaceutical and physician insurance claims datasets for all BC residents for 2 years following the 2009 policy change. We assessed the number and types of drugs renewed by pharmacists, and whether these complied with the policy. Further, we matched pharmacist-renewed prescriptions to equivalent potentially renewable prescriptions and assessed the impact on ambulatory physician visits.
  
  
  RESULTS
  Over the first 2 years, pharmacists renewed 150,950 prescriptions in BC. Almost one-half of these renewals did not appear to match the conditions set out in the new regulatory policy (n = 69,970, 47%). Those that did match the conditions (n = 80,980, 53%) represented a very small proportion of the 47 million prescriptions that pharmacists could have renewed (0.17%). The most frequently renewed medications were treatments for dyslipidemias, hypertension, diabetes, and gastroesophageal reflux disease. Pharmacist-renewed prescriptions were preceded by a 30% relative decrease in ambulatory physician visits in the week before dispensing, but there was also a 17% relative increase in visits in the week following the pharmacist-renewed prescription.
  
  
  CONCLUSIONS
  Overall, the use of pharmacist renewals was very low and one-half of the renewals were not policy-concordant. Pharmacist renewals were associated with the intended reductions in physician visits before dispensing, but there was also an unintended increase in visits after dispensing. These findings suggest that future policies such as this one need to be differently designed and closely monitored.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.forename: Lucy
authors.initials: L
authors.lastname: Cheng
authors.forename: Jillian
authors.initials: J
authors.lastname: Kratzer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
authors.forename: Carlo
authors.initials: C
authors.lastname: Marra
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D001955:British Columbia; D002908:Chronic Disease / Q000188:drug therapy*; D003157:Community Pharmacy Services / Q000331:legislation & jurisprudence / Q000592:standards; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007885:Legislation, Pharmacy; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010595:Pharmacists / Q000331:legislation & jurisprudence / Q000592:standards; D011050:Policy Making; D017410:Practice Guidelines as Topic; D024382:Professional Role; D013997:Time Factors