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

Investigating Physicians\u27 Compliance with Drug Prescription Notifications

The objective of this study was to investigate physicians\u27 compliance with recommendations for drug substitutes embedded within an electronic medical record, to assess factors affecting compliance, and to evaluate associated cost savings. An exploratory study of all physicians in all clinics operated by a large health maintenance organization (HMO) was conducted using a transparent computerized agent that collected 1.21 million prescriptions prescribed by 647 physicians. Compliance with HMO recommendations for substitute drugs reached a 70 percent rate. Substitute type, whether generic or therapeutic, was found to be the most significant factor affecting compliance, with physician workload and age second and third in effect magnitude, respectively. Compliance was found to be non-automatic and selective, following a thoughtful cognitive process. The HMO realized at least a 4 percent reduction in costs for prescribed drugs as a result of compliance with substitute recommendations. The results can be interpreted via the lens of Organizational Justice Theory, assuming that the broad compliance with generic substitutes was driven by perception of just procedures, whereas there was no such perception in the case of therapeutic substitutes. While more research is warranted for investigating the motivations driving physicians\u27 compliance, we strongly feel that the results can be generalized to other HMOs and healthcare settings

SIMULATED MEDICAL ENCOUNTERS TO ANALYZE PATIENT-PHYSICIAN COMMUNICATION DURING ELECTRONIC MEDICAL RECORDS\u27 USE IN PRIMARY CARE

The implications of the patient-physician relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician and it has been suggested that good patient-physician communication can improve healthcare outcomes. The incorporation of Electronic Medical Records (EMRs) in primary care provides an opportunity for improving healthcare services and quality of care. EMRs have, without a doubt, transformed the dynamics of the medical encounter. Implications of EMRs on the patient-physician communication, and thus on healthcare quality, have not yet reached a full understanding. Existing physician communication skills assessment tools do not take into account the physician\u27s need to divert his/her attention from the patient to the computer, and vise versa. One such tool is the SEGUE. This research-in-progress paper aims to describe the preliminary steps taken to assess the adequacy of the existing SEGUE tool in evaluating physicians\u27 communication skills in a computerized environment based on simulated medical encounters. Assuming that the existing SEGUE tool does not capture the new dynamics of the medical encounter; we suggest that it should be enhanced to include best-practices for physicians\u27 EMR use while maintaining effective communication with patients. We intend to develop a set of items which reflect recommendations for EMR use aimed at maintaining effective communication with the patient. These new items will be formulated based on an extant literature review and experts panel, and will eventually be incorporated into the existing SEGUE tool to provide a comprehensive tool for analyzing physicians\u27 communication skills in the computerized clinic

Defining localities of inadequate treatment for childhood asthma: A GIS approach

BACKGROUND: The use of Geographic Information Systems (GIS) has great potential for the management of chronic disease and the analysis of clinical and administrative health care data. Asthma is a chronic disease associated with substantial morbidity, mortality, and health care use. Epidemiologic data from all over the world show an increasing prevalence of asthma morbidity and mortality despite the availability of effective treatment. These facts led to the emergence of strategies developed to improve the quality of asthma care. THE OBJECTIVE: To develop an efficient tool for quality assurance and chronic disease management using a Geographic Information System (GIS). GEOGRAPHIC LOCATION: The southern region of Israel. January 1998 – October 2000. DATABASES: Administrative claims data of the largest HMO in Israel: drug dispensing registry, demographic data, Emergency Room visits, and hospitalization data bases. METHODS: We created a list of six markers for inadequate pharmaceutical treatment of childhood asthma from the Israeli clinical guidelines. We used this list to search the drug dispensing registry to identify asthmatic children who received inadequate treatment and to assess their health care utilization and bad outcomes: emergency room visits and hospitalizations. Using GIS we created thematic maps on which we located the clinics with a high percentage of children for whom the treatment provided was not in adherence with the clinical guidelines. RESULTS: 81% of the children were found to have at least one marker for inadequate treatment; 17.5% were found to have more than one marker. Children with markers were found to have statistically significant higher rates of Emergency Room visits, hospitalizations and longer length of stay in hospital compared with children without markers. The maps show in a robust way which clinics provided treatment not in accord with the clinical guidelines. Those clinics have high rates of Emergency Room visits, hospitalizations and length of stay. CONCLUSION: Integration of clinical guidelines, administrative data and GIS can create an efficient interface between administrative and clinical information. This tool can be used for allocating sites for quality assurance interventions

An Innovative Influenza Vaccination Policy: Targeting Last Season's Patients

Influenza vaccination is the primary approach to prevent influenza annually. WHO/CDC recommendations prioritize vaccinations mainly on the basis of age and co-morbidities, but have never considered influenza infection history of individuals for vaccination targeting. We evaluated such influenza vaccination policies through small-world contact networks simulations. Further, to verify our findings we analyzed, independently, large-scale empirical data of influenza diagnosis from the two largest Health Maintenance Organizations in Israel, together covering more than 74% of the Israeli population. These longitudinal individual-level data include about nine million cases of influenza diagnosed over a decade. Through contact network epidemiology simulations, we found that individuals previously infected with influenza have a disproportionate probability of being highly connected within networks and transmitting to others. Therefore, we showed that prioritizing those previously infected for vaccination would be more effective than a random vaccination policy in reducing infection. The effectiveness of such a policy is robust over a range of epidemiological assumptions, including cross-reactivity between influenza strains conferring partial protection as high as 55%. Empirically, our analysis of the medical records confirms that in every age group, case definition for influenza, clinical diagnosis, and year tested, patients infected in the year prior had a substantially higher risk of becoming infected in the subsequent year. Accordingly, considering individual infection history in targeting and promoting influenza vaccination is predicted to be a highly effective supplement to the current policy. Our approach can also be generalized for other infectious disease, computer viruses, or ecological networks