Discussion
In the period 1 March 2016–1 March 2018, altogether 12 % of all electronic prescriptions registered in the summary care record were never dispensed by a pharmacy. Why are prescriptions not collected? This study cannot answer this question with any certainty, but the figures suggest some factors that may be the cause.
Many of the drugs in the non-dispensed prescriptions are available without prescription. It is likely that the patients – despite higher prices in some cases – choose the prescription-free alternative instead of having their prescription dispensed.
The second group that stands out includes drugs to be taken as needed or for bouts of illness. Some patients may want to have a prescription 'on standby', but failed to have it dispensed before the expiry date.
Some patients discontinue their medication themselves and thereby do not collect their prescription, and sometimes the patient is told by their doctor to stop using a drug without the prescription being withdrawn.
Lack of compliance with medication regimes is another possible cause. It is a well-known fact that some patients fail to comply with their doctors' recommendations for medication use. In a Danish study from 2014, it was found that 9.3 % of the patients who started drug-based therapy in general practice failed to collect their prescriptions (1) . In a similar study from Iceland, which compared the number of prescriptions written by GPs with the number dispensed, it was found that 6.2 % of the prescriptions were never collected (2) . However, some possible explanations can also lie with the prescribing doctors.
The administration department for electronic prescriptions has studied the quality of the national database Reseptformidleren and found that approximately 15 % of the patients were registered with duplicate prescriptions (3) . In some cases this is undoubtedly correct, but it may also happen that a therapist makes changes to a drug-based treatment plan and sends a new prescription to the database without withdrawing the old one. A valid prescription therefore remains registered with an old dosage that the patient is not to use. It is not inconceivable that some of the prescriptions that appear in this study as non-dispensed are such duplicates.
Another possible cause of non-dispensed electronic prescriptions is the use of the paper-based multidose form. When patients transition to multidose, a requisition form is sent to the pharmacy. This form functions as a paper-based prescription for up to one year. In the summary care record it has been observed that many doctors issue electronic prescriptions for drugs that are supplied in multidose packages. Since the pharmacy dispenses the drugs based on the paper-based requisition form, the electronic prescriptions are registered as non-dispensed. Some of the electronic prescriptions that appear in this study are likely to be for such multidose drugs.
Limitations
Limitations
Since the summary care record was not fully implemented until the spring of 2017, the sample does not include 100 % of the prescriptions that were issued during this period. However, there is no reason to believe that the relative relationship between issued and non-dispensed prescriptions is affected by this to any appreciable extent. The summary care record had been implemented in all health regions at that time, although there were some isolated areas in the north, south and east of the country that had not yet adopted it. In the same period, paper-based prescriptions accounted for slightly more than 10 % of the total. This assessment applies only to electronic prescriptions, but it is hard to imagine that the relationship is significantly different for paper-based prescriptions.