Students and Doctors are Unaware of the Cost of Drugs they Frequently Prescribe

Given the increasing healthcare costs of an ageing population, there is growing interest in rational prescribing, which takes costs of medication into account. We aimed to gain insight into the attitude to and knowledge of medication costs of medical students and doctors in daily practice. This was a cross‐sectional electronic survey among medical students (bachelor/master) and doctors (consultants/registrars). Attitude to costs was evaluated using a cost‐consciousness scale. In open questions, the participants estimated the cost of commonly prescribed (generic/non‐generic) drugs (including separate pharmacy dispensing costs). They were asked where they could find information about drug costs. Overall, a reasonable cost‐consciousness was found. Students were less conscious of the cost than were doctors (15.56 SD 3.25 versus 17.81 SD 2.25; scale 0–24; p = 0.001). In contrast to this consciousness, actual estimated drug costs were within a 25% margin for only 5.4% of generic and 13.7% of proprietary drugs (Wilcoxon signed‐rank, p < 0.001). The price of generic drugs was frequently overestimated (77.5%) and that of proprietary drugs was underestimated (51.4%). The dispensing costs were estimated correctly for 30% of the drugs. Most doctors (84%) and a minority of students (40%) were able to identify at least one source of information about drug costs. While doctors and students considered it important to be aware of the cost of drugs, this attitude is not reflected in their ability to estimate the cost of frequently prescribed drugs. Cost awareness is important in therapeutic reasoning and cost‐effective prescribing. Both should be better addressed in (undergraduate) pharmacotherapy education.     

抗高血压药物使用现状的调查与分析

目的调查郑州大学第五附属医院门诊抗高血压药物的使用情况。方法采用限定日剂量方法(DDD),对2011年第一季度该院门诊处方抗高血压药使用情况进行统计分析。结果排在用药频度前三位的分别是钙拮抗剂、血管紧张素Ⅱ受体拮抗剂和β-受体阻滞剂,联合用药处方占调查处方的66.67%,以二联用药为主。结论该院抗高血压药物的使用基本符合高血压治疗原则。     

Formulary-control procedures in a staff-model health maintenance organization

Efforts to promote cost-effective drug prescribing in a health maintenance organization (HMO) through (1) revision of the formulary, (2) education, and (3) drug-use evaluations (DUEs) are described. New programs and procedures to promote more cost-effective prescribing were implemented in 1987 at a staff-model HMO with seven health-care centers and 40,000 members. Support to the pharmacy and therapeutics committee in developing formulary recommendations was enhanced, the formulary was revised and the number of listed drugs reduced by half, the focus of pharmacists was changed from purchasing and inventory control to education of physicians about cost-effective prescribing, and the most expensive drug categories were identified and educational efforts instituted. During the next two years substantial changes in the prescribing of oral contraceptives, nonsteroidal anti-inflammatory drugs, antiulcer agents, and anti-infectives, but not antihypertensive drugs, were identified through DUEs. Evaluation of cost savings was limited by the lack of an automated, integrated patient database, and it was difficult to assess the effect of changes in patient population. Revision of the formulary coordinated with enhanced educational efforts and DUEs resulted in more cost-effective prescribing in an HMO without placing severe restrictions on physicians or patients.     

2007---2009年口服抗高血压药应用分析

目的：分析常熟医院口服抗高血压药的应用现状及发展趋势。方法：对2007--2009年我院口服抗高血压药的种类、用量、销售金额、用药频度、日均费用等进行回顾性分析。结果：我院口服抗高血压药用量呈上升趋势;血管紧张素Ⅱ受体拮抗剂、钙通道阻滞剂、血管紧张素转换酶抑制剂为临床一线药;血管紧张素Ⅱ拮抗阻滞剂用量及比例逐年上升,而血管紧张素转换酶抑制剂用量比例呈下降趋势。结论：我院口服抗高血压药临床使用结构基本合理。     

Controlling financial variables--changing prescribing patterns

Techniques of formulary management, pharmacy and therapeutics committee intervention, and the use of clinical pharmacy services to change prescribing patterns and contain costs in hospital pharmacy departments are reviewed. Methods of using the formulary to contain costs include deletion of generic and therapeutic equivalents, inclusion of therapeutic categories and cost codes, and regular reviews and updates of its contents. Drug monographs for formulary evaluation prepared for the P & T committee should include a comparative review of other drugs in the therapeutic category and a cost impact statement. The P & T committee can help contain costs by developing policies for automatic stop orders and restricted drug use. Clinical pharmacy activities that can result in cost savings include physician education (focused on prescribing), target drug programs, target disease programs, pharmacist participation on TPN and i.v. therapy teams, and patient training programs for home care. A matrix for evaluating cost-containment activities is presented. By tailoring the described methods to departmental personnel resources and hospital needs, the pharmacy can be effective in controlling costs.     

Experience with a two-tiered therapeutic interchange policy

A university hospital's formulary policy for therapeutic interchange is described in which pharmacists can routinely interchange some drugs but must contact the prescribers before interchanging other drugs. For drugs that are not automatically interchanged by the pharmacy, the formulary contains a "class representative," which pharmacy may change as relative prices of drug products change. When a non-formulary drug for which there is a designated class representative is prescribed, pharmacy contacts the prescriber. When a class representative for injectable histamine H2-receptor antagonists was being selected, previous positive and negative experiences with establishing therapeutic equivalence for antimicrobial agents were considered. The implementation of H2 antagonist therapeutic equivalence included the following steps: determining potential cost savings, reviewing the literature, consulting with specialty practitioners, presenting the information to the pharmacy and therapeutics committee, distributing formal bids, and educating hospital staff. Before cimetidine was designated the class representative, 84% of orders for injectable H2 antagonists were for ranitidine; one year later, 90% were for cimetidine. Orders for oral H2 antagonists also changed from predominantly ranitidine to predominantly cimetidine. The hospital's total costs for H2 antagonists decreased 8.4% in one year. The two-tiered approach to therapeutic interchange can reduce drug costs and increase the scope of agents deemed therapeutic equivalents in a manner that is acceptable to physicians and pharmacists.     

2008—2010年卫生部北京医院口服抗高血压药应用分析

目的:分析我院口服抗高血压药的应用情况,为临床合理用药提供参考。方法:对2008—2010年我院口服抗高血压药的种类、用量、销售金额、用药频度(DDDs)、限定日费用(DDC)等进行回顾性分析。结果:我院口服抗高血压药用量呈上升趋势;钙通道阻滞剂、血管紧张素Ⅱ受体阻断剂、β受体阻断剂、血管紧张素转换酶抑制剂为临床一线药;血管紧张素Ⅱ受体阻断剂用量及比例逐年上升,以血管紧张素Ⅱ受体阻断剂加中效利尿剂制成的复方制剂正在逐步取代血管紧张素转换酶抑制剂,而血管紧张素转换酶抑制剂用量比例呈下降趋势。结论:我院口服抗高血压药临床使用基本合理。     

某高校社区门诊离退休教工抗高血压药的使用分析

目的了解和分析某社区门诊离退休教工抗高血压药的使用情况。方法抽查1 264例(2011年3月)门诊离退休高血压患者处方,详细统计及分析。结果 5大类抗高血压药中,钙拮抗药(CCB)使用率最高,达到51.91%,β-肾上腺素受体阻滞药(β-阻滞药)占14.49%,血管紧张素转化酶抑制药(ACEI)占9.22%,血管紧张素Ⅱ受体抑制药(ARB)占11.33%,利尿药占1.45%。采用单种抗高血压药治疗1 018例(占80.54%),联合使用2种或2种以上抗高血压药246例(占19.46%),利尿药联合使用率占13.82%。结论该社区门诊抗高血压药的种类及联合用药符合《中国高血压防治指南》的要求,基本合理规范,但抗高血压药物联合应用较少、利尿药的使用率偏低。     

上海嘉定地区社区医院门诊抗高血压药物处方分析

目的了解和分析上海嘉定区5家样本社区医院门诊患者抗高血压药物的临床使用情况。方法采集样本社区医院2011年1月-2013年12月门诊电子处方进行统计分析,包括年龄和性别对高血压的影响、联合用药情况。结果钙拮抗剂（CCB）、血管紧张素转化酶抑制剂（ACEI）、血管紧张素Ⅱ受体拮抗剂（ARB）、β受体阻断剂、利尿剂5类抗高血压药物的处方张数占采集到的门诊总处方张数的25.28%,其中CCB、ARB和β受体阻断剂的使用频率最高。联合用药占全部抗高血压药物处方量的17.04%,其中以二联用药为主。结论上海嘉定地区样本社区医院门诊抗高血压药物的使用基本合理,单药治疗以CCB和ARB为主,仅少部分抗高血压药物的联合用药不合理。     

江苏省老年医院2008—2010年抗高血压药用药分析

目的:系统分析江苏省老年医院2008—2010年抗高血压药的应用情况。方法:对本院抗高血压药的品种、销售金额、用药频度(DDDs)、药品日费用进行回顾性分析。结果:本院抗高血压药用量呈上升趋势;钙离子拮抗剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β-受体阻滞剂及利尿剂为一线用药;ARB用量及比例逐年上升,而ACEI用量及比例呈下降趋势。钙离子拮抗剂的销售金额和DDDs在3年中排名第一。结论:本院抗高血压药临床用药结构基本合理,符合老年高血压病人推荐用药。