Roberts S J, Bateman D N, Smith J M
Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne.
Br J Gen Pract. 1997 Jan;47(414):13-8.
The volume and cost of prescribing varies considerably between practices. This variation is at least in part due to the prescribing behaviour of individual doctors, who are often faced with a range of therapeutically equivalent generic and brand-name drugs.
To assess the impact on general practitioners' prescribing behaviour of promoting therapeutically equivalent lower cost prescribing in conjunction with an incentive scheme.
Annual prescribing data from before (1992-93) and after (1993-94) implementation of the incentive scheme were compared retrospectively for general practices in the former Northern Regional Health Authority. Main outcome measures were the practices' 1993-94 rates of prescribing relative to those in 1992-93 for 18 drugs prescribed by brand name, of which 10 were targeted in the promotion, and for 14 drugs or classes of drugs either with equivalent cheaper alternatives or of limited clinical value (10 targeted and four not).
For 17 of the 18 drugs, brand name prescribing rates were significantly lower in 1993-94. Reductions in rates were greater for the 10 drugs appearing in the scheme's promotional literature. For other cost-saving measures, total prescribing rates were lower for seven classes of drugs, unchanged for one, but higher for the other six, all of which had been targeted. According to the growth in their overall per capita prescribing costs between the two study years, the 499 practices were categorized as low, average or high. Overall costs and individual prescribing rates for the majority of drugs studied were similar for these three practice groups in 1992-93. In 1993-94, practices' changes in prescribing volume differed between the groups, with the lowest increases in the low cost-growth group for all but one of the 32 classes of drugs.
Generic substitution was more easily implemented than more complex hints regarding cost-saving substitutions. Practices with smaller overall cost growth were making greater use of cost-beneficial prescribing strategies, whether promoted or otherwise. Simple messages may improve the cost-effectiveness of prescribing in the UK. With information support and encouragement, many prescribers appear to have modified their prescribing habits.
不同医疗机构的处方量和成本差异很大。这种差异至少部分归因于个体医生的处方行为，他们常常面临一系列治疗等效的通用名药物和品牌药。
评估结合激励计划推广治疗等效的低成本处方对全科医生处方行为的影响。
对前北方地区卫生局各医疗机构1992 - 93年（激励计划实施前）和1993 - 94年（激励计划实施后）的年度处方数据进行回顾性比较。主要结局指标是各医疗机构1993 - 94年相对于1992 - 93年18种品牌药的处方率，其中10种是推广目标药物，以及14种有等效廉价替代品或临床价值有限的药物或药物类别（10种为目标药物，4种非目标药物）。
18种药物中有17种在1993 - 94年的品牌药处方率显著降低。计划宣传资料中出现的10种药物的处方率降幅更大。对于其他节省成本措施，7类药物的总处方率降低，1类不变，但其他6类升高，这6类均为目标药物。根据两个研究年份间人均处方总成本的增长情况，将499家医疗机构分为低成本增长、中等成本增长和高成本增长三类。在1992 - 93年，这三类医疗机构中大多数研究药物的总体成本和个体处方率相似。1993 - 94年，不同组间医疗机构的处方量变化不同，除32类药物中的1类外，低成本增长组的增幅最小。
通用名药物替换比关于节省成本替换的更复杂提示更容易实施。总体成本增长较小的医疗机构更多地采用了成本效益好的处方策略，无论是否为推广策略。简单的信息可能会提高英国处方的成本效益。在信息支持和鼓励下，许多开处方者似乎改变了他们的处方习惯。
