The Effects of Managerial Intervention on Drug Prescribing

The Effects of Managerial Intervention on Drug Prescribing Patterns at King Chulalongkorn Memorial Hospital

Background § Thailand economic crisis in 1997 § cutting of public finance as well as the public health care budget & Thai currency devaluation § King Chulalongkorn memorial hospital new policy on 1 st March 1998 § New hospital drug list § Generic prescribing and dispensing policy

The new hospital drug list of King Chulalongkorn Memorial hospital Drug list List 1 1 1 R 2 1 R 3 1 R 4 1 R 5 List 2 Prescribing limitation 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

Characteristics of prescription before and after the implementation BEFORE AFTER Total 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

The cost of drugs in each class (1) GI Blood deriv Blood coag CVS Respi Antihis Neuromuscular

The cost of drugs in each class (2) Antiinfective Antineo plastic Hormone Electrolyte EENT Skin unclassified

Baht Cepha losporin Peni cillins Erythro mycins Tetra cycline Quino lones Sulfo Anti namides fungal the cost of systemic anti-infective drugs Antiviral

The percentage of prescribed drugs after generic prescribing policy % Generic name Trade name Combination drugs Hospital formulary

The percentage of prescribed and dispensed drugs after the generic prescribing and dispensing policy Prescribed drugs Dispensed drugs 90. 43 84. 27 71. 84 % 60. 72 39. 28 28. 16 15. 72 9. 57

conclusion § Key lessons from this work § The short term productivity of the implementation not only reduced the drug expenditure but also facilitated better drug management. § Implicatation of this work § Specific studies in the future research

conclusion § Implicatation from this work § Establish effective essential drug list § containing suitable drug items that cover all the possible therapeutic conditions § maintain the quality of treatment § The generic prescribing and dispensing policy § should be strictly implemented or maintained to all hospitals § the quality of generic drugs under good manufacturing practice (GMP) and bioequivalence study is required § Specific studies in the future research

conclusion § Specific studies in the future research § long-term study (at least 6 months) of drug categories which caused high cost from prescriptions. § cardiovascular drugs § systemic anti-infective agents