Transcript Poster presentation

The Effects of Managerial Intervention on Drug Prescribing Patterns
at King Chulalongkorn Memorial Hospital
Limpanathikul W, Wangsaturaka D, Nantawan P, Itthipanichapong C, Thamaree S, Withayalertpanya S,
Ketcharoen A, and Tangphao O.
Department of Pharmacology, Faculty of Medicine,Chulalongkorn University and Pharmacy Department,
King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Abstract:
After Thailand economic crisis in 1997, King Chulalongkorn Memorial Hospital had to establish
a new hospital drug list for reducing the drug expenditure. Generic prescribing and dispensing
policies were also implemented at the same time. This study aimed to evaluate the impact of the
new implementation by comparing the prescription patterns before and after the
implementation. The prescriptions from the pharmacy outlets for the outpatient departments
(OPDs) were systematically sampled five weeks before and after the implementation. Overall
characteristics of the prescriptions including total number of prescriptions; items and cost of
drug; average number of items/prescription; cost/prescription and cost/item; and the percentage
of prescribed generic drugs were collected and analyzed.
The total number of analyzed prescriptions and the average number of drug items/prescription
before and after the hospital drug list were similar. However the total cost/prescription and the
cost/item were decreased after the implementation (844+54.04 Baht vs 633+41.1 Baht and
332.58+29.59 Baht vs 255.29+19.98 Baht, respectively). After the generic prescribing and
dispensing policy implementation, physicians in the hospital increasingly prescribed drugs by
generic names (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and
received by patients more than before (90.43% vs 84.27% and 60.72% vs 28.15%, respectively).
From this short term study, it appears that the new hospital drug list and the generic prescribing
and dispensing policies seemed to play a part on drug expenditure reduction. This
implementation may also change the prescribing attitude of the physicians in King
Chulalongkorn Memorial Hospital.
Background
During Thailand economic recession (19972000), public finance was cut including the
public health care budget. The price of
imported pharmaceuticals and medical
equipments was also escalated due to Thai
currency devaluation. There were several
suggestions for reducing drug expenditure
budget including restriction of hospital
formulary or generic prescribing and
dispensing policy. The economic crisis led the
Ministry of Public Health (MPH) to set up
Background
schedules for reducing drug items available in the
National Essential Drug List (NEDL). King
Chulalongkorn Memorial hospital also established a
hospital drug list based on the new NEDL. The
hospital pharmacists in collaboration with medical
special list carefully selected drugs for the list. The
new list was implemented on March 1st, 1998. The
generic prescribing and dispensing policy was also
taken place at the same time.
The new hospital drug list of King Chulalongkorn
Memorial hospital
Drug list
List 1
1
1R1
1R2
1R3
1R4
1R5
List 2
Prescribing limitation
Reimbursable
-essential drugs, prescribed by any physicians
-prescribed by medical staffs
-prescribed by only specialists
-prescribed in In Patient Department (IPD)
-narcotics and psychotropic drugs
-prescribed under the permission of the director of
the hospital
Non-reimbursable
Objective
This study aimed to evaluate the short term
productivity of the new hospital drug list
and the generic prescribing and dispensing
policy by comparing the prescription
patterns in out patient departments (OPDs)
before and after the hospital drug list
implementation.
Methods
A retrospective-prospective descriptive study was
carried out after the new hospital drug list
implementation. Prescriptions within 5 weeks prior to
the implementation from the pharmacy outlets for
OPDs at King Chulalongkorn Memorial hospital were
systematically sampling. During the on going
implementation, the prescriptions were sampling in
the same way from the same places for 5 weeks. The
information from these prescriptions was collected
and analyzed.
Results
Table 1. Characteristics of prescription before and after
the implementation
BEFORE
AFTER
Total No. of prescription
2,049
2,052
Total No. of items
5,084
4,983
Total cost of drug
1,690,484
1,282,343
Average No. of
items/prescription
Average cost/prescription
2.52 + 0.04
2.45 + 0.03
844 + 54.04
633 + 41.11
Average cost/items
332.6+29.6
255 + 19.98
Fig. 1.1 The cost of drugs in each class
Baht
400 ,000
350 ,000
300 ,000
250 ,000
Before
After
200 ,000
150 ,000
100 ,000
50 ,000
0
GI
Blood
deriv
Blood
coag
CVS
Respi
Antihis
Neuromuscular
Baht
Fig. 1.2 The cost of drugs in each class
300 ,000
250 ,000
200 ,000
Before
After
150 ,000
100 ,000
50 ,000
0
Antiinfective
Antineo
plastic
Hormone Electrolyte
EENT
Skin
unclassified
Fig. 2 the cost of systemic anti-infective drugs
Baht
200 ,000
180 ,000
160 ,000
140 ,000
120 ,000
Before
After
100 ,000
80 ,000
60 ,000
40 ,000
20 ,000
0
Cepha Peni
losporin cillin
Erythro
mycin
Tetra
cycline
Quino
lone
Sulfa
Anti
fungal
Antiviral
Fig. 3 The percentage of prescribed drugs after generic
prescribing policy
50
45
40
35
%30
Before
After
25
20
15
10
5
0
Generic
name
Trade
name
Combination
drugs
Hospital
formulary
Fig.4 The percentage of prescribed and dispensed drugs
after the generic prescribing and dispensing policy
100
80
% 60
40
20
0
Prescribed drugs
Dispensed drugs
90.43
84.27
71.84
60.72
39.28
28.16
15.72
9.57
original
local
original
local
Before
After
conclusion
From this short term study, it can be concluded
that the new hospital drug list and the generic
prescribing and dispensing policy can reduce drug
expenditure at King Chulalongkorn Memorial
hospital. If this implementation was maintained in
the long run, it should be benefit for both the
hospital and the country. However the quality of
generic drugs under good manufacturing practice
(GMP) and bioequivalence study is required.
Acknowledgement
-King Chulalongkorn Memorial hospital grant
-personnel in the pharmacy department