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

The long march to catch-up: A history-friendly model of China’s mobile communications industry

This paper develops a history-friendly model of the process of catch-up by Chinese firms in the mobile communications industry. It aims to explain how the sectoral environment in terms of segmented markets and generational technological change facilitated the catch-up of domestic firms with respect to foreign multinationals. Segmented markets provided a nurturing environment in peripheral markets for the survival of domestic firms starting with low level capabilities in their infant stage. Generational technological change opened windows of opportunities for domestic firms to catch-up with foreign multinationals in new product segments. Segmented markets and generational technological change allowed domestic firms to leverage their initial advantages in peripheral markets to catch-up in core markets. Counterfactual simulations highlight that the process of catch-up was facilitated by relatedness across technological generations. This paper contributes to the literature on catch-up and industry evolution by illustrating the role of technological change and market regimes in the process of catching-up

Publisher Correction: Single-cell analysis of experience-dependent transcriptomic states in the mouse visual cortex.

In the version of this article initially published, the x-axis labels in Fig. 3c read Vglut, Gad1/2, Aldh1l1 and Pecam1; they should have read Vglut+, Gad1/2+, Aldh1l1+ and Pecam1+. In Fig. 4, the range values were missing from the color scales; they are, from left to right, 4-15, 0-15, 4-15 and 0-15 in Fig. 4a and 4-15, 4-15 and 4-8 in Fig. 4h. In the third paragraph of the main text, the phrase reading "Previous approaches have analyzed a limited number of inhibitory cell types, thus masking the full diversity of excitatory populations" should have read "Previous approaches have analyzed a limited number of inhibitory cell types and masked the full diversity of excitatory populations." In the second paragraph of Results section "Diversity of experience-regulated ERGs," the phrase reading "thus suggesting considerable divergence within the gene expression program responding to early stimuli" should have read "thus suggesting considerable divergence within the early stimulus-responsive gene expression program." In the fourth paragraph of Results section "Excitatory neuronal LRGs," the sentence reading "The anatomical organization of these cell types into sublayers, coupled with divergent transcriptional responses to a sensory stimulus, suggested previously unappreciated functional subdivisions located within the laminae of the mouse visual cortex and resembling the cytoarchitecture in higher mammals" should have read "The anatomical organization of these cell types into sublayers, coupled with divergent transcriptional responses to a sensory stimulus, suggests previously unappreciated functional subdivisions located within the laminae of the mouse visual cortex, resembling the cytoarchitecture in higher mammals." In the last sentence of the Results, "sensory-responsive genes" should have read "sensory-stimulus-responsive genes." The errors have been corrected in the HTML and PDF versions of the article