| No.30/2003
Research Findings |
Health and Community Care Research Programme |
Direct Supply of Medicines in Scotland: Extended Monitoring of a Pilot Scheme
Christine Sheehy and Lyn Jones, Scottish Health Feedback
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Minor ailments can generally be managed through the use of products available over the counter (OTC) from community pharmacies. However, people exempt from prescription charges may visit their GP to get a prescription instead. The aim of the Direct Supply of Medicines (DSoM) Scheme was to allow such exempt patients to consult a community pharmacy and receive OTC medicines free of charge under the NHS. An evaluation of this pilot scheme was conducted between April 2001 and March 2002 in two areas of Scotland (Schaftheutle et al , 2003). In view of the slow take up of the scheme in the initial 12 month pilot period, it was decided to continue monitoring registration onto and use of the scheme for a further six months. |
Main Findings
- Over the extension pilot period a further 458 people in Area 1 and 90 people in Area 2 registered with the DSoM scheme bringing the total registered to 1636 in Area 1 and 625 in Area 2.
- By the end of the extended pilot period, 5.6% of patients registered with GPs in Area 1 had registered with the scheme and 26.9% in Area 2.
- 73% (78% in Area 1 and 67% in Area 2) of consultations with the community pharmacy for minor ailments were by those exempt by age - a similar proportion as in the main pilot period. Patients with income-related exemptions accounted for 23% of consultations compared to 19% of consultations in the main pilot phase.
- In the main pilot phase head lice was the most frequently presented condition at community pharmacies followed by pain and cough. This position was maintained in the extension phase in Area 1 with head lice being involved in a even greater proportion of consultations (46% in the extension phase compared to 37% in the main phase). In Area 2 the proportion of consultations involving head lice dropped from 14% to 9%.
- As in the main pilot period there were wide variations in the number of consultations carried out by each participating pharmacy in the extension period; consultations ranged from 6 in one pharmacy to 415 in another.
- The cost of medicines prescribed by community pharmacies under the scheme during the extension pilot period was 2624.42 (2098.38 in Area 1 and 526.04 in Area 2).
- In Area 1 two thirds of the cost was associated with the treatment of head lice. In Area 2 just under a third of the cost was associated with the treatment of this condition.
- The average cost per consultation was 2.87 in Area 1, an increase of 47p over the main pilot phase, and 2.07 in Area 2, an increase of 48p.
Introduction
The DSoM scheme was introduced into two areas in Scotland - one a small town on the east coast (Area 1) and the other an ex-mining village in the south-west (Area 2). Under the scheme patients exempt from prescription charges could register with a local participating pharmacy. On consultation for a range of minor ailments, community pharmacists were able to prescribe products from an agreed, limited formulary. Products in the formulary reflected GP prescribing practice in that area. The pilot scheme ran from April 2001 to March 2002. An evaluation of the scheme was undertaken and reported in Schaftheutle et al (2003).
At the end of the 12 month pilot period the scheme had not reached a steady state. In order to determine whether registrations would continue to climb and to record use of the scheme, monitoring of these two elements was extended for a further six months.
Methods
Consultations with community pharmacists under the scheme were recorded by the pharmacist throughout the extension pilot period (April 2002 - September 2002). Details of exemption status, presenting condition and product prescribed or other outcome were recorded.
The cost of prescriptions issued in connection with consultations was obtained from the Primary Care Information Unit.
Records of people registering with the scheme were obtained from the project co-ordinator in Area 1 and the GP practice in Area 2.
Figure 1 Number of patients registering with scheme (monthly) - Area 1 and Area 2 April 2001 - September 2002
Figure 2 Number of consultations per month Area 1 and Area 2 April 2001 - September 2002
Registration onto the scheme
Over the course of the extension pilot period a further 458 people in Area 1 and 90 people in Area 2 registered with the scheme bringing the total registered to 1636 in Area 1 and 625 in Area 2. The number of people registering on to the scheme each month over the whole eighteen month pilot period is shown in Figure 1 below.
As in the main phase, more females registered with the scheme than males particularly in Area 1. The scheme also continued to attract more registrations for the younger age groups (0-4 and 5-15 year olds) than the older one (60 and over) particularly in Area 1 where almost three quarters of those registering in the extension period were in the two youngest age groups. This difference was not so marked in Area 2 where 40% of new registrants were in the youngest age groups. However although an average of 76 people registered with the scheme each month in Area 1, new registrations ceased altogether in Area 2 in August and September suggesting that registrations in this area may have reached a peak.
Use of the scheme
A further 738 consultations were recorded in Area 1 and 255 in Area 2 although it was clear that there was significant under recording in this phase of the pilot (278 consultations not recorded in Area 1 and 88 in Area 2).
Over the extension period there was an equivalent annual consultation rate of 1.01 consultations (0.85 in Area 1 and 1.08 in Area 2) indicating that over this period registrants, on average, could be expected to use the scheme about once per year. This was a decrease on use recorded over the first twelve months of the pilot. Over the whole 18 month period of the Pilot (main phase and extension) an equivalent annual consultation rate of 1.35 in Area 1 and 1.41 was recorded.
However as in the main phase of the pilot, the consultation rate was much higher among younger age groups than older ones. Almost twice as many females as males consulted the community pharmacist under the scheme.
Age exemptions accounted for 78% and 67% of consultations in Area 1 and Area 2 respectively. About a quarter of consultations in each area were due to income related exemptions.
As in the main pilot phase cough, pain and head lice were the most frequently presented conditions. Head lice were involved in 46% of all consultations in Area 1 and 8.6% of consultations in Area 2 over the extension period.
The cost per consultation increased in both areas in the extension phase (2.87 in Area 1 and 2.07 in Area 2) and costs in Area 1 remained higher than in Area 2. About a quarter of prescriptions in Area 1 and just under a third of those in Area 2 cost under a 1. The cost of head lice treatments already accounting for a high proportion of total costs in the main pilot phase rose by 6% to 66% of all prescription costs in Area 1. In contrast, Area 2 costs for head lice treatments fell by about half to 13%.
There was little change in the cost per condition between the extension phase of the pilot and the main phase.
Conclusion
At the end of the first 12 months of the pilot scheme registration with and use of the scheme had not reached a steady state in either pilot site. By extending the monitoring of these two aspects of the pilot for a further six months it was hoped the scheme would move closer to a steady state and therefore provide a better indication of how such a 'mature' scheme would operate.
Data collected over this extended pilot period suggests that whilst the scheme in Area 2 may have reached a steady state at around 27% of the total practice population, the scheme in Area 1 still has some way to go to reach this state. An element of caution is needed in extrapolating this finding to other areas which may have populations with a very different sociodemographic make up and a less close relationship with their local community pharmacy. However this suggests that potentially a further 8000 people may register with the scheme in Area 1.
In both pilot areas there appears to be an element of 'data recording fatigue' by community pharmacists in recording consultations. In Area 1, the community pharmacies were also responsible for registering new recruits onto the scheme. Throughout the pilot some pharmacies were more pro-active about this than others however in the extension pilot phase there appeared to be a wider spread decline in registering new recruits.
Over the extension pilot period there was an annual consultation rate of 1.01 (0.85 in Area 1 and 1.08 in Area 2). Overall, an annual consultation rate of 1.37 (1.35 for Area 1 and 1.41 for Area 2) was recorded for the whole eighteen months of the pilot. This suggests that as the scheme moves closer to a steady state that people registered with the scheme will use it on average once a year.
Reference
Schaftheutle, E, Noyce, P, Sheehy, C and Jones, L (2003) Direct Supply of Medicines in Scotland: Evaluation of a Pilot Scheme, Scottish Executive Social Research