Transcript Poster presentation

A LONGITUDINAL POLICY
ANALYSIS OF THE IMPACT ON
PRESCRIBING PATTERNS AND
MEDICATION COST OF A
GENERIC DISPENSING POLICY IN
A TEACHING HOSPITAL IN
THAILAND
A LONGITUDINAL POLICY ANALYSIS OF THE IMPACT ON PRESCRIBING
PATTERNS AND MEDICATION COST OF A GENERIC DISPENSING POLICY
IN A TEACHING HOSPITAL IN THAILAND
Anansakunwatt W*, Suttipoom P*,Wagner A**, Ross-Degnan D**,
Wongtanasuporn Y*
* Siriraj Hospital, Mahidol University, Thailand; ** Harvard Medical School,
Boston, USA
Problem Statement: At Siriraj Hospital, as in many other hospitals, preferential
prescribing of brand name products contributes to large and increasing drug
expenditures.
Objectives: To estimate the impact of a hospital-wide generic dispensing policy
on prescribing patterns and cost of medication and to explore healthcare
professionals’ and patients’ perceptions of the policy.
Design: Retrospective, interrupted time series study of monthly computerized
inventory data and in-patient and out-patient dispensing records, from one year
before to one year after the policy. Cross-sectional assessment of health care
professionals’ and patients’ perceptions of the policy using standardized
questionnaires. Segmented linear regression, with adjustment for autocorrelation,
was used to analyze time series data.
Setting and Population: Siriraj hospital, a 2,324 bed tertiary care teaching
hospital, where more than 3,000 outpatient prescriptions per day are filled.
Intervention: In October 2001, the hospital administration implemented a
generic dispensing regulation to lower medication expenditures by authorizing
pharmacists to automatically dispense a generic product unless the prescriber
specifically requests dispensing of the brand name product.
Outcome Measures: Post-policy change in % of drugs dispensed as generic,
average drug cost per prescription, total cost of drugs dispensed from pharmacy,
compared to before the policy and accounting for pre-policy levels and trends in
these measures; policy perception among professionals and patients.
Results: Generic substitution policy caused % of drugs dispensed as generic
increased and drug cost decreased in a substitutable group (p=0.00) and saved
1.998 million USD per year. The cost of products that are available as brand-only
(non-substitutable) drugs increased but not influenced by the policy. Average
drug cost per prescription did not change. Most physicians’, nurses’ and
pharmacists’ perceptions of the generic dispensing policy are concern about
generic drug quality and they understand the rationale of this policy
implementation. Most patients (89.23 %) were satisfied by this policy.
Conclusions: The policy saved drug cost and both personnel and patients were
not unsatisfied by the policy implementation .
Funding Source: United States Agency for International Development.
Background
 Siriraj Hospital, 2,324 bed
university hospital in Thailand
has more than 2,000 items of
drug.
 In October 2001, the hospital
administration implemented a
generic dispensing regulation to
lower medication expenditures
by authorizing pharmacists to
automatically dispense a
generic product unless the
prescriber specifically requests
dispensing of the brand name
product by adding the symbol ®
after the original brand name.
Research Questions
 How did hospital medication
use and expenditures change?
 How did the rate of generic
dispensing of selected
medications change?
 How did the use of selected
medications that are available
as brand-only change?
 How did average prescription
cost change?
 What are physicians’, nurses’
pharmacists’ and patients’
perceptions of the generic
dispensing policy?
Methods
(1) an analysis of medication
consumption data based on
pharmacy stock records in the
year before and the year after
implementation of the generic
dispensing policy
(2) a longitudinal study of
prescribing and dispensing
patterns between October 1,
2000 and September 30, 2002
(3) a cross-sectional qualitative
study of physicians’, nurses’,
pharmacists’ and patients’
perceptions of the generic
dispensing policy.
Result 1: Dispensing of
substitutable original brands
decreased and generic products
increased significantly by the
policy (p=0.00).
Substitutable Generic
product
Policy start
Generic only
Brand only
Substitutable
Original brand
Result 2: Cost of substitutable
original brands decreased and generics
increased by the policy (p=0.00) and
saved 1.998 million USD per year but
the cost of unique brands increased by
month influence (p=0.003)
Brand only
Policy start
Substitutable
Original brand
Substitutable
Generic product
Generic only
Picture of OPD Drug Cost
Result 2: Cost of substitutable
original brands decreased and
generics increased by the policy
(p=0.00) and saved 1.998 million USD
per year but the cost of unique brands
increased by month influence
(p=0.003)
Policy start
Substitutable Original
brand
Brand only
Substitutable
Generic product
Generic only
Picture of IPD Drug Cost
Result 3 : Cost per
prescription did not change
significantly.
Policy start
Result 4: Generic
dispensing of selected popular
drugs increased significantly
Policy start
Generic
Omeprazole cap.
Original
Losec MUPs
Policy start
Generic
Furosemide inj.
Original
Lasix inj.
Policy start
Generic
Glipizide
Original
Minidiab
Survey Results
DISTRIBUTED
RETURNED
%
PRESCRIBER
452
219
48.45
PHARMACIST
40
26
65.00
NURSE
486
439
90.33
PATIENT
496
496
100.00
Summary
 Generic substitution policy caused
drug cost decreased in a
substitutable group (p=0.00) and
saved 1.998 Million USD per year.
 The cost of products that are
available as brand-only (nonsubstitutable) drugs increased and
caused total drug cost of this
subgroup rising but was not
influenced by the policy.
 The cost per prescription did not
change.
 89.23% of patients were satisfied by
the generic drug substitution policy.
 Physicians’, nurses’ and pharmacists’
perceptions of the generic dispensing
policy
 Concern about generic drug quality
 Understand why this policy was
implemented
Recommendations
 The hospital administrators
should implement new
policies to
 Assure the quality of drugs
accepted in the hospital
formulary.
 Control the use of new
original brands that are high
cost items.
 Review drug use pattern
regularly and feedback to
prescribers.