Transcript Abstract - WHO archives

IMPROVING
ECONOMIC PRESCRIBING
IN A TEACHING HOSPITAL THROUGH
AN EDUCATIONAL STRATEGY
TO PROMOTE
GENERIC PRESCRIBING
Improving Economic Prescribing in a Teaching Hospital through an Educational
Strategy to Promote Generic Prescribing
Suttipoom P*, Anansakunwatt W*, Ngamthipwatthana T*, Wagner A**, Ross-Degnan D**
* Siriraj Hospital, Mahidol University, Thailand; ** Harvard Medical School, Boston, USA
Problem Statement: Medication costs are escalating when precious resources could be
saved through more widespread use of lower-cost generic products rather than more
expensive brand name medications.
Objective: To assess the impact on generic prescribing and drug costs of a multi-method
educational intervention for physicians by hospital pharmacists about medication quality and
costs.
Design: Interrupted time series with comparison series of prescribing patterns and drug costs.
Fifty percent of antibiotic and antihistamine (comparison series) prescriptions per month
were systematically sampled during 9 months before, 4 months during, and 6 months after
the intervention (December 1999 – June 2001). Segmented linear regression, adjusting for
autocorrelation, was used to analyze the data.
Setting: Ear-Nose-and-Throat (ENT) department of a tertiary care teaching hospital with
more than 4,000 outpatient visits per day.
Study Population: All staff physicians(n=23)and residents(n=27) from the ENT department.
Intervention: A multi-method educational intervention. Physicians discussed issues of
generic prescribing in peer group meetings with a local opinion leader. They received
feedback about their own prescribing patterns, and printed materials comparing generic and
brand product prices and quality in the form of posters, pocket cards, booklets, and stickers.
Interventions targeted only antibiotic prescribing. Antihistamine prescribing was studied to
assess whether physicians transferred information about generic prescribing to another drug
class.
Outcome Measures: Percent of antibiotics and antihistamines prescribed as generics; cost of
antibiotics per prescription.
Results: Generic antibiotic prescribing for the whole ENT group did not statistically change
after the intervention. But generic prescribing of the frequently prescribed antibiotics,
roxithromycin, increased from 19.4% to 37.7% (p=0.00004) and co-amoxiclav increased
from 52.09% to 64.20% (p=0.048) . Overall, drug costs decreased by 4.5 Bahts per
prescription per month, for a total cost saving of 676,440.72 Bahts (16,911 USD) per year.
Generic antihistamine prescribing also increased, from 17.4% to 66.5% (p=0.00000008) for
the most frequently used antihistamine, cetirizine.
Conclusions: A multi-method educational intervention did not result in increasing of generic
prescribing of all targeted antibiotics but only roxithromycin and co-amoxiclav. The
information of generic prescribing was transferred to a non-targeted drug class. Generic
prescribing and dispensing should be encouraged through educational and other interventions
Study Funding: United States Agency for International Development (USAID)
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
Background (con.)
Factors influence prescribing patterns
• Believe that Brands are more effective
• Prescribe Brands for a long time
• Learn from senior prescribers
• Lack of information about price and quality
of Brands and Generics
• Prescribe Brands if patients can pay or can
reimburse
• Hospital policy : not authorize pharmacist to
substitute Brands with Generics
Estimation
Generics prescribing of only 6 popular
expensive brands could save 35 million Bahts
( 875,000 USD )
( 5% of pharmaceutical expenditure )
( Wimon et al 1997 )
Objective
: To assess the impact on generic
prescribing and drug cost of
a multi-method educational
intervention for physicians
by hospital pharmacist about
medication quality and cost
Study Questions
: Will an educational intervention lead
to increase in generic prescribing ?
: Will an educational intervention
transfer the effect to another drug
class ?
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
Duration
–9 months before, 4 months during and 6 months
after intervention (December 1999 – June 2001)
Study Population
–Staff physicians and residents from Ear-NoseThroat (ENT) Department
Interventions
A multi-method educational
intervention
– Questionnaires
– Providing drug price information
– Providing information of quality
assurance of generic substitution
products using printed materials
: posters , pocket cards and booklets
– Group discussion
(with opinion leaders )
Intervention targeted only antibiotic
prescribing
Antihistamine prescribing was studied to
assess learning effect ( comparison series)
Results
Effects on prescribing pattern
For all antibiotics :
Generic prescribing did not increase significantly
Results
Effects on prescribing pattern (con)
For Roxithromycin :
Generic prescribing increased from 19.4% to 37.7%
(p = 0.00004)
Generic unit price = 5 Bahts
Brand unit price = 14 Bahts
Results
Effects on prescriber status
For Staff physicians :
Roxithromycin generic prescribing increased significantly (p = 0.0005)
For Residents (Non staff) :
Roxithromycin generic prescribing did not increase significantly
Results
Learning effect
For all antihistamine :
Generic prescribing increased significantly
(p = 0.00)
Results
Learning effect (con)
For Cetirizine :
Generic prescribing increased from 17.4% to 66.5%
(p = 0.00000008)
Generic unit price = 1 Bahts
Brand unit price
= 9 Bahts
Effects on cost
Drug cost per prescription per month decreased 4.5 Bahts, total cost
saving of 676,440.72 Bahts (16,911 USD) per year
Conclusion
A multi-method educational intervention can not
increase in generic prescribing of all targeted
antibiotics except roxithromycin and co-amoxiclav.
The information of generic prescribing can be
transferred to a non-targeted drug class,
antihistamines.
Implementations
1.Hospital policy change
Since October 2001 prescriptions of Brands have been
automatically substituted with Generics if prescribers do
not emphasize Brands by the symbol ®
2.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