A review of methods of drug cost management in hospitals

Prescribing new drugs: a survey of hospital consultants in the West Midlands

Objective

To investigate the factors that influence how consultants introduce new drugs into their clinical practice.

Method

A postal questionnaire survey of hospital consultants.

Setting

169 consultants in medical specialties in six hospitals (general or teaching hospitals) in the West Midlands region, United Kingdom.

Key findings

Ninety-two completed questionnaires (54 per cent) were returned. Eighty consultants (87 per cent) reported using a new drug in the previous two years; 60 (65 per cent) had used either one or two new drugs and these were generally in their specialist field. There was no significant difference between hospitals in how easy it was to introduce a new drug. Sixty-one consultants (67 per cent) said that the procedure required an application to the hospital drug and therapeutics committee. Consultants frequently asked patients' general practitioners to prescribe a new drug. Consultants rated independent sources of information more highly than non-independent sources. The most important factors reported to influence prescribing decisions about new drugs were drug characteristics, such as efficacy and safety, and evidence from scientific literature. Sixty-four respondents (70 per cent) saw drug company representatives up to once a week and 57 (62 per cent) had been involved in clinical trials of new drugs in the previous five years.

Conclusion

In general, the consultants reported that they used only a small number of new drugs. There is considerable pressure on hospital doctors to control prescribing and costs of new drugs through policies that require approval by the drug and therapeutics committee. Although contact with the pharmaceutical industry was high, consultants reported that independent sources of information were more important. Factors such as clinical trial evidence and improved drug characteristics were said to be the most influential in reaching decisions to prescribe new drugs.

Target drug programs and medication use evaluation

Target drug programs and medication use evaluations are activities that are undertaken to improve the correct use of drugs. These programs should focus on inappropriate drug use, drug use problems, optimizing use of drugs, and improving the level of patient care. To monitor the effects of the programs, several types of outcomes have been evaluated, such as economic and financial, clinical quality, quality of life, patient satisfaction, and collaborative practice. The methodology to classify and monitor drug use incorporates the classification system developed by the World Health Organization, which takes into account each drug's anatomic, therapeutic, and chemical classification. In order to avoid focusing only on drugs and drug costs in these programs, and to allow for monitoring the impact of the programs on clinical practice, linking drug data to patient data is stressed. Target drug programs improve the appropriate use of drugs, and by doing so, contribute to safe and rational use of drugs in society.