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Understanding medication oversupply and its predictors in the outpatient departments in Thailand

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journal contribution
posted on 2016-01-15, 00:00 authored by P. Dilokthornsakul, N. Chaiyakunapruk, P. Nimpitakpong, N. Jeanpeerapong, K. Jampachaisri, T.A. Lee
Background: Medication oversupply is an important problem in the healthcare systems. It causes unnecessary avoidable healthcare costs. Although some studies have determined the magnitude and financial loss due to medication oversupply in western countries, they may not be applicable to Asia-pacific countries. This study aims to determine the prevalence, financial loss, and patterns of medication oversupply and the factors associated with such oversupply in Thailand. Methods: A retrospective database analysis was used from 3 public hospitals. Patients visiting the outpatient department of the hospitals in 2010 and receiving at least 2 prescriptions within 6 months were included. The modified medication possession ratio (MPRm) was used to determine the medication supply. Patients having MPRm > 1.20 were defined as receiving a medication oversupply. The measures were prevalence of medication oversupply, the number of oversupplied medications, and financial loss (2012 dollars) due to medication oversupply. Hierarchical logistic regression was used to determine the factors associated with the prevalence of medication oversupply. Results: A total of 99,743 patients were included. Patients were on average 49.7 ± 21.2 years of age, and 42.8% were male. Most of them were adult (53.7%). Among those patients, 60.2% of the patients were under universal coverage schemes. Around 13.4% of all the patients received a medication oversupply, and the patients in regional hospitals had a higher prevalence of medication oversupply than patients in district hospitals (13.8% VS 8.2%). The patients under civil servant medical benefit schemes (CSMBS) (13.6%) had the most prevalence of medication oversupply. The total financial loss was $189,024 per year. The average financial loss was $1.9 ± 19.0 per patient/ year. Patients under CSMBS experienced the highest average financial loss (2.6 ± 23.2 $/patient/year). Age, gender, health insurance schemes, and the number of medications that the patients received were the factors associated with medication oversupply. Conclusions: Medication oversupply is an important problem for the health system. Patients receiving care from regional hospitals had a higher likelihood of medication oversupply. Policymakers may consider developing policies for preventing medication oversupply. The policy should be implemented in regional hospitals and especially in children or patients with poly-pharmacy


We would like to express our appreciation to Dr. Supasit Pannarunothai and Dr. Rungpetch Sakulbumrungsil for their critical comments on this article. The authors wish to thank Buddhachinaraj hospital, Sunpasitthiprasong hospital, and Nakhon Thai Crown Prince hospital for providing data for this study. The authors also would like to thank the Thailand Research Fund through the Royal Golden Jubilee PhD program (grant No. PHD/0356/2550 to PD) for the supporting financial grant for the PhD program and the health system research institute for an additional grant.


Publisher Statement

This is a copy of an article published in the BMC Health Services Research © 2014 BioMed Central Publications. © 2014 Dilokthornsakul et al.


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