Schectman J M, Schroth W S, Elinsky E G, Ott J E
George Washington University Medical Center, Washington, DC 20037, USA.
HMO Pract. 1996 Sep;10(3):119-22.
To examine the effect of an intervention designed to reduce antihistamine prescribing costs in an HMO.
A quasi-experimental design with clinicians at one HMO site receiving an intervention. Their prescribing behavior before and after the intervention was compared to the prescribing behavior of clinicians at other HMO sites in a non-randomized control group.
A mixed model HMO in metropolitan Washington, DC.
Group model clinicians at a single site received the intervention; network and group model clinicians at other sites composed the control group.
An education memo addressed to clinicians discussing antihistamine prescribing costs and strategies for initial use of nonprescription or less expensive prescription agents, coupled with free antihistamine sample "trial packs" for patient use.
The prescribing costs of the intervention group were compared to the prescribing costs of the non-randomized control group. The intervention group was surveyed regarding their attitudes toward the intervention.
A 2% decline in costs was noted between the baseline and intervention year for both the intervention and control groups. Though clinicians indicated they were well disposed toward the intervention, they believe patient expectations were a major obstacle to the use of cheaper agents.
We conclude that an effective intervention would require the targeting of major patient-related barriers to clinician behavior change.
探讨一项旨在降低健康维护组织（HMO）中抗组胺药处方成本的干预措施的效果。
采用准实验设计，对一家HMO机构的临床医生进行干预。将干预前后他们的处方行为与非随机对照组中其他HMO机构临床医生的处方行为进行比较。
华盛顿特区大都会区的一个混合型HMO。
单个机构的团体模式临床医生接受干预；其他机构的网络模式和团体模式临床医生组成对照组。
向临床医生发送一份教育备忘录，讨论抗组胺药处方成本以及初始使用非处方或较便宜处方药的策略，并为患者提供免费的抗组胺药样品“试用包”。
将干预组的处方成本与非随机对照组的处方成本进行比较。对干预组进行关于他们对干预措施态度的调查。
干预组和对照组在基线期和干预期之间的成本均下降了2%。尽管临床医生表示他们对干预措施持积极态度，但他们认为患者的期望是使用更便宜药物的主要障碍。
我们得出结论，有效的干预措施需要针对与患者相关的主要障碍，以改变临床医生的行为。
