Association between prescription patterns and primary care clinic closures in South Korea: A longitudinal retrospective cohort study.

Background: Primary care clinic sustainability affects healthcare service delivery. However, the impact of prescription patterns on primary care clinic sustainability remains unclear. We analyzed the association between prescription patterns of frequently used medications and primary care clinic closures in South Korea.

Methods: We used Korean National Health Insurance Service data on office-based primary care clinics established between 2003 and 2012, and their claims data from January 1, 2002 to December 31, 2015. We assessed the effects of prescription patterns on primary care clinic closures in Korea. Prescription patterns included prescription rates of benzodiazepines and injectable medications for all visits, antibiotics for upper respiratory tract infections, and steroids for musculoskeletal diseases. We calculated these rates for the first year after the establishment of each clinic. We adjusted the association for patient-group- and clinic-related factors over 12 years. We used multivariate Cox proportional hazards regression for analyses.

Results: Among 14,525 clinics, 4,681 were closed during the observation period. The average follow-up period was 5.3 years. An increase in the benzodiazepine prescription rate was associated with a lower risk of closure (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.82-0.92, per 10% point increase; p < 0.001). Steroid prescriptions for musculoskeletal diseases influenced clinic closure (HR: 0.96; 95% CI: 0.94-0.99, per 10% point increase; p = 0.002). Prescription rates of antibiotics for upper respiratory tract infections (HR: 1.00; 95% CI: 0.98-1.01; p = 0.496) and any injectable medications (HR: 0.99; 95% CI: 0.97-1.01; p = 0.247) did not affect primary care clinic closure.

Conclusions: Steroid and benzodiazepine prescriptions were linked to lower clinic closure risk, while antibiotic and injectable prescriptions were not. These findings suggest that evidence-based prescribing may not compromise clinic viability and that appropriate care and sustainability can be achieved together through informed policy.