Transcript Abstract - WHO archives

IMPROVING ECONOMIC PRESCRIBING
IN A TEACHING HOSPITAL
THROUGH
AN EDUCATIONAL STRATEGY
TO PROMOTE GENERIC PRESCRIBING
Premjit Suttipoom
Wimon Anansakunwatt
Thienchai Ngamthipwatthana
Anita Wagner
Dennis Ross-Degnan
Background
Siriraj Hospital : Mahidol University
• 4,426 outpatients per day
• 2,324 beds in 172 wards
• 786 physicians
• 2500 items of hospital formulary
Hospital formulary
• Brand or original medications ( Brands )
• Brand only
• Brand with generic substitute
• Multi-source lower-priced pharmaceutical
equivalent medications ( Generics )
• Generic only
• Generic with brand substitute
Study Questions
: Will an educational intervention
 lead to increase in generic prescribing ?
 transfer the effect to another drug class ?
Interventions
A multi-method educational intervention
• Group discussion (with opinion leaders )
• Providing drug price information
• Providing quality assurance information of generic
substitution products using printed materials
: posters , pocket cards and booklets
Interventions
Targeted only antibiotic prescribing
Antihistamine prescribing was studied to
assess learning effect
( comparison series)
Duration
9 months before, 4 months during and
6 months after intervention
(December 1999 – June 2001)
9 Months
Intervention
4 Months
6 Months
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6
December
1999
August
2000
December
2000
June
2001
A multi-method educational intervention
Face to Face Communication
A multi-method educational intervention
Pocket Cards
A multi-method educational intervention
Booklets: inform price of antibiotics
A multi-method educational intervention
Poster inform about drug quality
A multi-method educational intervention
Group Discussion
Methods
Design
•Interrupted time series of prescribing patterns and drug
costs
•Sampling 50 % of antibiotic and antihistamine
prescriptions per month
Outcome Measures
•% Generic prescribing of antibiotic and antihistamine
•% Brand prescribing of antibiotic and antihistamine
• Cost of antibiotic and antihistamine per prescription
Results
Effects of the intervention on
Generic prescribing of
 All antibiotics
 Top 3 antibiotics
Prescriber status
Generic prescribing of
 All antihistamines
(Learning Effect)
Cost
Results
For all antibiotics
Generic prescribing did not increase significantly
Results
Amoxycillin
Generic prescribing did not increase significantly
Generic unit price = 3.00 Bahts
Brand unit price = 6.50 Bahts
Results
Co-amoxiclav
Generic prescribing increased from 52.09% to 64.20%
(p = 0.048)
Generic unit price = 19.80 Bahts
Brand unit price = 33.50 Bahts
Results
Roxithromycin
Generic prescribing increased from 19.4% to 37.7%
(p = 0.00004)
Generic unit price = 5.00 Bahts
Brand unit price = 14.00 Bahts
Market Share and Price of Top 3 Antibiotic
Increase
Generic
% Prescribing
Prescribing
Brand
Unit Price
(Baht)
Generic
Unit Price
(Baht)
Price
Difference
not sig.
38.00
6.50
3.00
3.50
Co-amoxiclav
p = 0.048
14.20
33.50
19.80
13.70
Roxithromycin
p = 0.00004
13.32
14.00
5.00
9.00
Amoxycillin
Results
Effects on prescriber status
For Staff physicians :
Roxithromycin generic prescribing increased significantly (p = 0.0005)
Learning Effect
For all antihistamine
Generic prescribing increased significantly
(p = 0.00)
Learning Effect (con)
Cetirizine
Generic prescribing increased from 17.4% to 66.5%
(p = 0.00000008)
Generic unit price = 1.00 Bahts
Brand unit price = 9.00 Bahts
Effects on Cost
Drug cost per prescription
decreased 4.5 Bahts per month
Total cost saving of 676,440.72 Bahts
(16,911 USD) per year
Conclusion
 A multi-method educational intervention
can improve economic prescribing of high
price difference antibiotics
but not in all targeted antibiotics
 The information of generic prescribing
can be transferred to a non-targeted drug
class
Implementations
Hospital policy change
Since October 2001 prescriptions of Brands
have been automatically substituted with
Generics if prescribers do not emphasize Brands
by the symbol ®
Implementations
Pharmacists’ role increase
for rational drug use
- educational intervention by
*newsletter (Siriraj Pharmletter)
*drug information center in the hospital
- encourage the pharmaceutical and therapeutic
committee to bring more generic drugs into
hospital formulary or select only 1 brand for 1
chemical
Acknowledgement
International Network for Rational Use of Drugs
Department of Essential Drugs and Medicine Policy, WHO
Center for International Health, Boston University School of Public
Health
Department of Ambulatory Care & Prevention, Harvard Medical School
RPM Plus and SEAM Programs, Management Sciences for Health
Thai Network for Rational Use of Drugs
U.S. Agency for International Development
Dr. Dennis Ross-Degnan
Dr. Anita Wagner
Dr. Sauwakon Ratanawijitrasin
Thank you