Pharmaceutical care can be defined as “the care that a given patient requires and receives
which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication
is an important link in the health care chain, and the supply of chronic medication specifically
was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic
disease and related deaths are increasing in low- and middle-income countries, causing 39%
and 72% of all deaths in low- and middle-income countries respectively.
The main objective of this study was to investigate the difference between chronic medication
prescribing patterns and subsequent claiming patterns for community (retail) and mail order
(courier) pharmacies in the South African private health care sector.
Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted
from the database of a South African pharmaceutical benefit management company. The
chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N =
42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative,
retrospective, cross-sectional drug utilisation review was conducted, and data were analysed
using the Statistical Analysis System® programme.
Various providers of chronic medication were analysed, namely dispensing doctors, dispensing
specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97%
of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n =
2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies
dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies
dispensed 4 900 282. The average cost per prescription for chronic medication at retail
pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier
pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected
according to the number of unique patients utilising these medications for at least four
consecutive months. The most utilised chronic medication groups were ACE inhibitors (n =
1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891)
and oral antidiabetics (n = 696 631).
The average medication possession ratio for retail pharmacies indicated that, on average,
statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail
pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with
the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy
medication costs.
The average chronic prescription, item and levy cost did not vary significantly between courier
and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is
similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic
medication groups, however, did differ significantly. In order to choose the most appropriate
provider, the medical scheme provider needs to consider the over- and undersupply of
medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future
noncompliance and associated health problems. The costs associated with undersupply of
medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014
| Identifer | oai:union.ndltd.org:NWUBOLOKA1/oai:dspace.nwu.ac.za:10394/10710 |
| Date | January 2013 |
| Creators | Coetsee, Janine Mari |
| Source Sets | North-West University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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