Project on exceptional dispensation in the Principality of Asturias

Community pharmacy (CF) is daily confronted with situations that prevent the proper dispensing of medication, putting at risk the continuity of treatment by patients, which causes medication-related problems (DRPs). In this pilot study, carried out in the Principality of Asturias, the aim was to quantify the number of incidents of this type related to those aspects of the prescription that could be easily corrected by the community pharmacist through simple interventions at the time of dispensing. It was carried out in ten pharmacies in this autonomous community during normal opening hours over fifteen working days. The sample included a total of 32,331 containers dispensed. A total of 406 incidences of exceptional dispensing were recorded. The total incidence rate reached 1.26% of the dispensations, which extrapolating to the total number of dispensations made in Asturias during the month of October 2020 would give us a figure of 27,030 total dispensations susceptible to exceptional dispensing.

The total incidence rate was lower in urban pharmacies (1.03%) compared to semi-urban and rural pharmacies (1.37% and 1.39%). Most of the cases (59.4 %) involved patients with an individual contribution to the Health System corresponding to 10 % (TSI2) and the mean age of the patient was 60.8 years. Regarding the level of care, 79% of the cases corresponded to Primary Care (PC) prescriptions. The most common type of incidence is “potential interruption due to prescription not active at the time of dispensing (exceeding the 10-day margin)” with an incidence rate of 0.61 % of the dispensations, which would mean a total of 13,181 prescriptions susceptible to exceptional dispensing due to this type of incidence.

In terms of economic savings, it was found that 63 of the 406 cases would have necessarily required a medical consultation and 30% of them would have been for active patients. Therefore, the remaining 343 cases, which could be resolved through exceptional dispensing by the community pharmacist, would mean a saving of more than 4,000 consultations and nearly 200,000 euros in direct and indirect costs if the pharmacist were allowed to intervene.