Ornstein S M, MacFarlane L L, Jenkins R G, Pan Q, Wager K A
Department of Family Medicine, Medical University of South Carolina, Charleston, USA.
Arch Fam Med. 1999 Mar-Apr;8(2):118-21. doi: 10.1001/archfami.8.2.118.
Medications account for 8% of national health care expenditures, and prescription drugs are a focus of cost containment measures. Physicians have limited knowledge about drug costs, and no method of providing this information has demonstrated sustained cost reductions.
To determine the impact of cost information in a computer-based patient record system on prescribing by family physicians.
A yearlong, controlled clinical trial was conducted at the Family Medicine Center, Medical University of South Carolina, Charleston, a group practice staffed by attending physicians and residents. Prescription cost information was included in the computer-based patient record system used at the center. During a 6-month period, cost information was not displayed; during the subsequent 6-month intervention period, costs were displayed at the time of prescribing. An intention-to-treat analysis was used to compare prescription costs between the control and intervention periods for all medications prescribed, and stratified analyses for several medication and physician factors were performed.
A total of 22,883 prescriptions were written during the 1-year study period. The mean +/- SD cost per prescription in the control period was $21.83 +/- $27.00 (range, $0.01-$510.00), and in the intervention period was $22.03 +/- $28.12 (range, $0.01-$435.96) (P = .61, Student t test). Increases in mean prescription cost and proportion of total costs were identified in 4 medication classes: antibiotics, cardiovascular agents, headache therapies, and antithrombotic agents. Decreases in mean prescription cost and proportion of total costs were identified in 5 medication classes: nonsteroidal anti-inflammatory drugs, histamine type 2-receptor antagonists and proton pump inhibitors, ophthalmic preparations, vaginal preparations, and otic preparations.
In this setting, the provision of real-time computerized drug cost information did not affect overall prescription drug costs to patients, although differences in individual medication classes were observed. The negative results of this study may reflect confounding due to the use of historical controls, suboptimal timing of the intervention in the prescribing process, susceptibility bias at the study site, or the insensitivity of prescribing habits to cost information.
药物支出占全国医疗保健支出的8%，处方药是成本控制措施的重点。医生对药物成本的了解有限，且尚无提供此类信息的方法能持续降低成本。
确定基于计算机的患者记录系统中的成本信息对家庭医生开药的影响。
在南卡罗来纳医科大学查尔斯顿分校家庭医学中心进行了一项为期一年的对照临床试验，该中心是一个由主治医师和住院医师组成的团体诊所。处方成本信息包含在该中心使用的基于计算机的患者记录系统中。在为期6个月的期间内，不显示成本信息；在随后为期6个月的干预期内，开药时显示成本。采用意向性分析比较对照期和干预期内所有开具处方的药物的处方成本，并对几种药物和医生因素进行分层分析。
在为期1年的研究期间共开具了22,883张处方。对照期每张处方的平均成本±标准差为21.83美元±27.00美元（范围为0.01美元至510.00美元），干预期为22.03美元±28.12美元（范围为0.01美元至435.96美元）（P = 0.61，Student t检验）。在4类药物中发现平均处方成本和总成本比例增加：抗生素、心血管药物、头痛治疗药物和抗血栓药物。在5类药物中发现平均处方成本和总成本比例下降：非甾体抗炎药、组胺2型受体拮抗剂和质子泵抑制剂、眼科制剂、阴道制剂和耳用制剂。
在此环境中，提供实时计算机化药物成本信息并未影响患者的总体处方药成本，尽管观察到个别药物类别存在差异。本研究的负面结果可能反映了由于使用历史对照、开药过程中干预时机欠佳、研究地点的易感性偏差或开药习惯对成本信息不敏感而导致的混杂情况。
