Tags

Type your tag names separated by a space and hit enter

Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation.
BMJ Open. 2018 12 18; 8(12):e021318.BO

Abstract

OBJECTIVES

To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free.

DESIGN

Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data.

SETTING

General practices, Scotland, UK.

PARTICIPANTS

732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013).

INTERVENTION

Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions.

PRIMARY AND SECONDARY OUTCOMES

Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS).

RESULTS

The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis.

CONCLUSIONS

This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.

Authors+Show Affiliations

European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro, UK.Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK.Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30567818

Citation

Williams, Andrew James, et al. "Impact of Abolishing Prescription Fees in Scotland On Hospital Admissions and Prescribed Medicines: an Interrupted Time Series Evaluation." BMJ Open, vol. 8, no. 12, 2018, pp. e021318.
Williams AJ, Henley W, Frank J. Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation. BMJ Open. 2018;8(12):e021318.
Williams, A. J., Henley, W., & Frank, J. (2018). Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation. BMJ Open, 8(12), e021318. https://doi.org/10.1136/bmjopen-2017-021318
Williams AJ, Henley W, Frank J. Impact of Abolishing Prescription Fees in Scotland On Hospital Admissions and Prescribed Medicines: an Interrupted Time Series Evaluation. BMJ Open. 2018 12 18;8(12):e021318. PubMed PMID: 30567818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation. AU - Williams,Andrew James, AU - Henley,William, AU - Frank,John, Y1 - 2018/12/18/ PY - 2018/12/21/entrez PY - 2018/12/21/pubmed PY - 2019/10/29/medline KW - administrative data KW - co-payment KW - fees, pharmaceutical KW - interrupted time series KW - natural experiment KW - quasi-experimental SP - e021318 EP - e021318 JF - BMJ open JO - BMJ Open VL - 8 IS - 12 N2 - OBJECTIVES: To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free. DESIGN: Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data. SETTING: General practices, Scotland, UK. PARTICIPANTS: 732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013). INTERVENTION: Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions. PRIMARY AND SECONDARY OUTCOMES: Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS). RESULTS: The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis. CONCLUSIONS: This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/30567818/Impact_of_abolishing_prescription_fees_in_Scotland_on_hospital_admissions_and_prescribed_medicines:_an_interrupted_time_series_evaluation_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=30567818 DB - PRIME DP - Unbound Medicine ER -