Influencing Physician Drug Prescription Habits Towards Cost Containment

In Israel, diffusion of clinical information systems is almost universal in ambulatory medical services. The drug prescription module embedded in a widely-used electronic patient record system has the capacity to intervene and notify physicians about available generic or therapeutic substitute drugs, when their first choice is outside the insurer\u27s preferred drug list. The objective of this paper is to study how such intervention influences drug prescription habits of physicians and helps contain costs. To this end we monitored system use for 40 weeks, recording physicians’ willingness to change their choice to a substitute following system notification. Findings show higher physician compliance with generic substitutes than with therapeutic substitutes, based on a cognitive decision process upon notification, and increase in compliance over time, until stabilization. The resulting direct financial savings on expenditure for drugs, estimated to be 4.7% for chronic drugs, entail long-term savings

Drug therapy - a challenge in primary care.

Introduction: Drug therapy in primary care is a broad field, with two areas previously identified as particularly challenging: treatment of the elderly and prescription of antibiotics against uncomplicated upper respiratory tract infections (URTIs). General practitioners’ (GPs’) attitudes and adherence to evidence-based treatment guidelines might be influenced by different interventions and need to be studied. Objectives: 1. To study different intervention models that might influence GPs’ adherence to treatment guidelines. 2. To describe GPs’ attitudes towards locally developed treatment guidelines. Methods: (Paper I) Systematic medication reviews by pharmacists were performed in a randomised controlled study of 369 elderly patients living in the community or nursing homes, who were using the multi-dose drug dispensing (MDD) system. Drug lists were assessed before and after the intervention with a focus on potentially inappropriate medications (PIMs). (Paper II) A retrospective analysis of medication lists was conducted in the same patient sample, with a focus on fall risk-increasing drugs (FRIDs), orthostatic drugs (ODs) and falls. (Paper III) A randomised controlled study was performed using two questionnaire-based behaviour change interventions aimed at reducing prescription of antibiotics against URTIs in primary care. (Paper IV) A qualitative study was performed using focus group interviews to assess GPs’ attitudes towards evidence-based local treatment guidelines. Results: Papers I and II: Systematic medication reviews by pharmacists reduced the number of patients taking PIMs and the total number of drugs these patients were taking, but not the number of patients taking more than three psychotropic drugs. A significant proportion (87%) of the study sample was taking FRIDs and ODs. Numbers of FRIDs were associated with the total number of drugs and with severe falls. There was no association between numbers of ODs and occurrence of severe falls. Paper III: There was a significant decrease in the antibiotic prescribing rate in one of the two intervention groups compared to the control group in patients 0-6 years, but no differences between the groups in patients of all ages. Paper IV: Trust in evidence-based recommendations and patient safety were found to be key factors in prescribing, as was the patient-doctor encounter, with emphasis on informing the patient. The GPs all experienced a lack of time to self-inform, difficulties managing patients with multiple prescribers and direct-to-consumer drug industry information. Cost containment was perceived as both a barrier and a motivator for adherence to guidelines. Conclusion: Multi-professional assessment of patient’s drug list and questionnaire-based behaviour change interventions might be feasible methods to improve quality of drug treatment in primary care and need to be studied further. GPs found trust in evidence-based guidelines and patient safety to be essential in drug prescribing

THE INFLUENCE OF BRAND EQUITY ON PRESCRIBER BEHAVIOUR IN A MULTISOURCE DRUG MARKET

When a patent expires, innovator (brand-name) drugs lose their monopoly status and new generic competitors are free to enter the market. Theoretically, free market entry and exit should lead to a drop in the price of the innovator drug as per the tenets of perfect competition. Yet instead of prices decreasing, innovator drug prices are often minimally impacted by generic competition and the innovator continues to maintain both market power and market share – a phenomenon labelled the generic competitor paradox (Scherer, 1993) That the expected supply and demand dynamic is less pronounced in multisource drug markets, suggests that non-price considerations influence purchasing behaviour in multisource prescription drug markets. This dissertation focuses on the marketing theory of brand equity to rationalise the non-price competitive advantages that established prescription innovator (brand-name) drugs have over newer bioequivalent generic entrants. By analysing the prescribing habits of physicians, we find that brand equity confers a competitive advantage to the innovator drug: Brand equity is cultivated during the period of patent granted monopoly and creates a first-mover market advantage that is reinforced by the strategic creation of brand loyalty, which serves as a barrier to entry for generic substitutes

Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

<p>Abstract</p> <p>Background</p> <p>Strategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs) regarding current cost control measures as well as their proposals for improving the effectiveness of these measures.</p> <p>Methods</p> <p>A qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader.</p> <p>Results</p> <p>GPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures.</p> <p>Conclusion</p> <p>Future investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns about injustice and feelings of impotence on the part of the GPs, which can lead to lack of interest in and disaffection with the current measures.</p

Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study

Background: Studies have emphasized the importance of geographical factors and general practitioner (GP) characteristics in influencing drug prescriptions. Objectives: To: (i) ascertain the prevalence rate (PR) of use of drugs in six therapeutic categories used for chronic conditions; (ii) assess how geographical characteristics and GP characteristics may influence drug prescribing. Methods: This study is part of the EDU.RE.DRUG Project, a national collaborative project founded by Italian Medicine Agency (AIFA). Cross-sectional analyses were undertaken employing the pharmacy-claim databases of four local health units (LHUs) located in two Italian regions: Lombardy and Campania. Six drug categories were evaluated: proton-pump inhibitors; antibiotics; respiratory-system drugs; statins; agents acting on the renin 12angiotensin system; psychoanaleptic drugs. The PR was estimated according to drug categories at the LHU level. A linear multivariate regression analysis was undertaken to evaluate the association between the PR and geographical area, age and sex of GPs, number of patients, and percentage of patients aged &gt;65 per GP. Results: LHUs in Campania showed a PR that was significantly higher than that in Lombardy. Antibiotics showed the highest PR in all the LHUs assessed, ranging from 32.5% in Lecco (Lombardy) to 59.7% in Naples-2 (Campania). Multivariate linear regression analysis confirmed the association of the PR with geographical area for all drug categories. Being located in Campania increased the possibility of receiving a drug prescription from the categories considered, with estimates more marked for antibiotics, proton-pump-inhibitors, and respiratory-system drugs. Conclusions: This study provides information about the PR of medications used for treating common and costly conditions in Italy and highlighted a significant geographical variation. These insights could help to develop area-specific strategies to optimize prescribing behavior