the effects of managerial intervention on drug prescribing patterns at king chulalongkorn memorial...
DESCRIPTION
Background schedules for reducing drug items available in the National Essential Drug List (NEDL). King Chulalongkorn Memorial hospital also established a hospital drug list based on the new NEDL. The hospital pharmacists in collaboration with medical special list carefully selected drugs for the list. The new list was implemented on March 1 st, The generic prescribing and dispensing policy was also taken place at the same time.TRANSCRIPT
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The Effects of Managerial Intervention on Drug Prescribing Patterns at King Chulalongkorn Memorial Hospital
Limpanathikul W, Wangsaturaka D, Nantawan P, Itthipanichapong C, Thamaree S, Withayalertpanya S, Ketcharoen A, and Tangphao O. Department of Pharmacology, Faculty of Medicine,Chulalongkorn University and Pharmacy Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Abstract: After Thailand economic crisis in 1997, King Chulalongkorn Memorial Hospital had to establish a new hospital drug list for reducing the drug expenditure. Generic prescribing and dispensing policies were also implemented at the same time. This study aimed to evaluate the impact of the new implementation by comparing the prescription patterns before and after the implementation. The prescriptions from the pharmacy outlets for the outpatient departments (OPDs) were systematically sampled five weeks before and after the implementation. Overall characteristics of the prescriptions including total number of prescriptions; items and cost of drug; average number of items/prescription; cost/prescription and cost/item; and the percentage of prescribed generic drugs were collected and analyzed.The total number of analyzed prescriptions and the average number of drug items/prescription before and after the hospital drug list were similar. However the total cost/prescription and the cost/item were decreased after the implementation (844+54.04 Baht vs 633+41.1 Baht and 332.58+29.59 Baht vs 255.29+19.98 Baht, respectively). After the generic prescribing and dispensing policy implementation, physicians in the hospital increasingly prescribed drugs by generic names (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and received by patients more than before (90.43% vs 84.27% and 60.72% vs 28.15%, respectively).From this short term study, it appears that the new hospital drug list and the generic prescribing and dispensing policies seemed to play a part on drug expenditure reduction. This implementation may also change the prescribing attitude of the physicians in King Chulalongkorn Memorial Hospital.
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BackgroundDuring Thailand economic recession (1997-2000), public finance was cut including the public health care budget. The price of imported pharmaceuticals and medical equipments was also escalated due to Thai currency devaluation. There were several suggestions for reducing drug expenditure budget including restriction of hospital formulary or generic prescribing and dispensing policy. The economic crisis led the Ministry of Public Health (MPH) to set up
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Background
schedules for reducing drug items available in the National Essential Drug List (NEDL). King Chulalongkorn Memorial hospital also established a hospital drug list based on the new NEDL. The hospital pharmacists in collaboration with medical special list carefully selected drugs for the list. The new list was implemented on March 1st, 1998. The generic prescribing and dispensing policy was also taken place at the same time.
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The new hospital drug list of King Chulalongkorn Memorial hospital
Drug list Prescribing limitationList 1
11R11R21R31R41R5
List 2
Reimbursable-essential drugs, prescribed by any physicians -prescribed by medical staffs-prescribed by only specialists-prescribed in In Patient Department (IPD)-narcotics and psychotropic drugs-prescribed under the permission of the director of the hospital
Non-reimbursable
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ObjectiveThis study aimed to evaluate the short term productivity of the new hospital drug list
and the generic prescribing and dispensing policy by comparing the prescription
patterns in out patient departments (OPDs) before and after the hospital drug list
implementation.
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MethodsA retrospective-prospective descriptive study was
carried out after the new hospital drug list implementation. Prescriptions within 5 weeks prior to
the implementation from the pharmacy outlets for OPDs at King Chulalongkorn Memorial hospital were
systematically sampling. During the on going implementation, the prescriptions were sampling in
the same way from the same places for 5 weeks. The information from these prescriptions was collected
and analyzed.
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Results
BEFORE AFTERTotal No. of prescription 2,049 2,052
Total No. of items 5,084 4,983
Total cost of drug 1,690,484 1,282,343
Average No. of items/prescription
2.52 + 0.04 2.45 + 0.03
Average cost/prescription 844 + 54.04 633 + 41.11
Average cost/items 332.6+29.6 255 + 19.98
Table 1. Characteristics of prescription before and after the implementation
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0
5 0 ,0 0 0
1 0 0 ,0 0 0
1 5 0 ,0 0 0
2 0 0 ,0 0 0
2 5 0 ,0 0 0
3 0 0 ,0 0 0
3 5 0 ,0 0 0
4 0 0 ,0 0 0
BeforeAfter
GI Bloodderiv
Blood coag
CVS Respi Antihis Neuromuscular
Baht Fig. 1.1 The cost of drugs in each class
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0
5 0 ,0 0 0
1 0 0 ,0 0 0
1 5 0 ,0 0 0
2 0 0 ,0 0 0
2 5 0 ,0 0 0
3 0 0 ,0 0 0
BeforeAfter
Anti-infective
Antineo
plastic
Hormone Electrolyte EENT Skin unclassified
Baht Fig. 1.2 The cost of drugs in each class
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0
2 0 ,0 0 0
4 0 ,0 0 0
6 0 ,0 0 0
8 0 ,0 0 0
1 0 0 ,0 0 0
1 2 0 ,0 0 0
1 4 0 ,0 0 0
1 6 0 ,0 0 0
1 8 0 ,0 0 0
2 0 0 ,0 0 0
BeforeAfter
Cephalosporin
Penicillin
Erythromycin
Tetracycline
Quinolone
Sulfa Antifungal
Antiviral
Fig. 2 the cost of systemic anti-infective drugsBaht
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0
5
1 0
1 5
2 0
2 5
3 0
3 5
4 0
4 5
5 0
BeforeAfter
Fig. 3 The percentage of prescribed drugs after generic prescribing policy
%
Generic name
Trade name
Combination drugs
Hospital formulary
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020406080100
original local original local
BeforeAfter
Fig.4 The percentage of prescribed and dispensed drugs after the generic prescribing and dispensing policy
%
Prescribed drugs Dispensed drugs90.43
84.27
9.5715.72
71.84
39.28
60.72
28.16
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conclusionFrom this short term study, it can be concluded that the new hospital drug list and the generic
prescribing and dispensing policy can reduce drug expenditure at King Chulalongkorn Memorial
hospital. If this implementation was maintained in the long run, it should be benefit for both the
hospital and the country. However the quality of generic drugs under good manufacturing practice
(GMP) and bioequivalence study is required.
Acknowledgement-King Chulalongkorn Memorial hospital grant-personnel in the pharmacy department