Introduction
Repeat dispensing has been identified as an essential service to be provided by all community pharmacies in the new pharmacy contract and is envisaged to improve the quality of care by re-designing services around patients. Since the initial pilot schemes in the late 1990’s, eighty Primary Care Trust repeat dispensing pathfinder sites have been set up. However, there has been no published review of the strength of the evidence for wider implementation of these activities. The purpose of this study was to provide a critical and comprehensive review of both peer reviewed and non-peer reviewed literature that referred to repeat dispensing in community pharmacy.

Method
Electronic databases (e.g. Medline^®, Embase^® and CINAL^®) were searched from 1992 to December 2004. This was supplemented by searching PJ-online^®, IJPP-online^® conference abstracts and the bibliographies of retrieved articles. Assessment of the transparency and systematicity of the retrieved papers was undertaken in which each study was allocated an evidence category based on the categories adopted by the National Service Frameworks. Data was abstracted from the retrieved papers and entered into a matrix using the following framework: location, reference, aim, design, participants, interventions and outcomes. Analysis of the findings explored patients’ and healthcare professionals’ satisfaction with the service, impact on workload, quality of care and possible savings on NHS drug budget.

Findings
Three randomised controlled trials (RCTs), one before-and-after trial and four observational studies were included. Thematic analysis of the retrieved papers indicated that patients’ satisfaction with repeat dispensing was high mainly as the service was seen as more convenient and time-saving. Whilst pharmacists considered that their relationship with patients had improved, patients did not agree and considered that pharmacists still remained in their dispensaries. Quality of care was considered by two RCTs, which indicated that more adverse reactions and compliance issues were identified in the intervention group. However, no direct comparisons were reported between differences in rates between intervention and control groups. Likewise, it was not possible to determine if any of the reported cost savings were solely attributable to repeat dispensing as direct comparisons between groups was not reported. The RCTs did not achieve Health Development Agency standards of transparency and systematicity as particular criteria were missing, e.g. indicating how the sample size was determined, how randomisation was achieved and implemented, and the estimated effect size and precision of primary outcomes were not reported.

Discussion
Definitive conclusions about the effectiveness and impact of repeat dispensing are difficult to draw given a lack of transparency and systematicity when reporting RCTs. Nevertheless, the findings indicate that there are high levels of patient satisfaction with the service and an increase in the quality of care that they receive. It was not possible to draw conclusions about the possible savings on the NHS drug budget. It is important that further research is designed to ensure definite conclusions regarding what impact this service has on patients, community pharmacists, GPs and the wider health economy.

1. PSNC. The new contract for community pharmacy. Aylesbury, PSNC. 2004.

2. Department of Health. Pharmacy in the Future - Implementing the NHS plan. London: Department of Health, 2001.

3. Health Development Agency Working definition of evidence and criteria for inclusion of non evidence briefing material http://www.hda-online.org.uk/evidence/criteria_qs.html (Accessed November 2004.)

4. Department of Health. National Framework for Older People. 2001.