Providing cost information to physicians reduces the use of expensive drugs and diagnostic tests

Evidence-based health care management Providing cost information to physicians reduces the use of expensive drugs and diagnostic tests "OM M ENTAR~ Beilby J J, Silagy C A. Trials of providing costing inforntation to general practitioners: a systematic review. Medical Journal of A ustralia 1997; 167:89-92 Objective To determine if providing utilization and cost information to general practitioners (GPs) reduces medical costs. Method Qualitative review of the literature. Literature review Articles containing keywords: 'family practice,' 'physicians, family,' 'primary health care,' 'knowledge, attitudes, practice,' 'comprehensive health care,' 'cost,' and 'fees and charges' were obtained from MEDLINE, CINAHL, Health Plan and EMBASE. From these, randomized studies of the provision of objective utilization measures to physicians were selected for review. Results Six studies meeting the criterion for review were identified, all of which found that providing cost and utilization information reduced the use of medical services and drugs. Three found that physicians ordered fewer diagnostic tests when given cost information in educational sessions or computerized printouts. Similarly, provision of information was found to be an effective means of reducing drug expenditures in two studies. Of these, one found that physicians given monthly printouts of their prescriptions substituted generic drugs for relatively more expensive brand name drugs. The other found that physicians decreased use of target drugs after meeting with a pharmacist to discuss their prescribing patterns. Four of the six studies measured the use of services and costs over a 12-month period. The decrease in costs was sustained over the entire period only in one of the studies. Authors' conclusions Programs in which physicians receive information about costs reduce medical expenditures in the short run, but their ability to produce sustained reductions in costs is unclear. © Harcourt Brace andCompany Ltd 1998 Medical costs are too high. What is the best way to reduce them? There are many ways. This article reviews six articles that examined whether providing cost information could change the behavior of GPs in ordering drugs, investigative tests, and specialty services. Four of the six studies assessed sustainability of the intervention over time, and only one of these found any long-term effect. It is this lack of sustained reduction in costs that has cast doubt on any effort to solicit voluntary participation among physicians in cost reduction programs. Similar studies have been carried out on medical specialists with similar findings. Cost reduction can be achieved as long as the study is carried out, but after completion of the experiment, most physicians, whether GPs or specialists, revert to their old (and more expensive) ways. Why is it so difficult to get physicians (who tend to be of above-average intelligence) to change their behavior? I believe part of the reason has to do with the education they receive in medical school or during their residency, where they are taught to overorder tests (lest the attending physician take them to task). It is rare that physicians in training are ever criticized for ordering too many drugs, tests or specialty services. Until this aspect of medical training is changed, it is unlikely that simple interventions will be able to change practices learned early in one's career. As the saying goes, old habits die hard. Richard Howard, Mo University o f Florida Gainsvilte, Florida, USA 46 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT JUNE 1998

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Transcript of Providing cost information to physicians reduces the use of expensive drugs and diagnostic tests

Evidence-based health care management

Providing cost information to physicians reduces the use of expensive drugs and diagnostic tests

"OM M ENTAR~

Beilby J J, Silagy C A. Trials of providing costing inforntation to general practitioners: a

systematic review. Medical Journal of A ustralia 1997; 167:89-92

Objective

To determine if providing utilization and cost information to general practitioners (GPs) reduces medical costs.

Method

Qualitative review of the literature.

Literature review

Articles containing keywords: 'family practice,' 'physicians, family,' 'primary health care,' 'knowledge, attitudes, practice,' 'comprehensive health care,' 'cost,' and 'fees and charges' were obtained from MEDLINE, CINAHL, Health Plan and EMBASE. From these, randomized studies of the provision of objective utilization measures to physicians were selected for review.

Results

Six studies meeting the criterion for review were identified, all of which found that providing cost and utilization information

reduced the use of medical services and drugs. Three found that physicians ordered fewer diagnostic tests when given cost information in educational sessions or computerized printouts. Similarly, provision of information was found to be an effective means of reducing drug expenditures in two studies. Of these, one found that physicians given monthly printouts of their prescriptions substituted generic drugs for relatively more expensive brand name drugs. The other found that physicians decreased use of target drugs after meeting with a pharmacist to discuss their prescribing patterns.

Four of the six studies measured the use of services and costs over a 12-month period. The decrease in costs was sustained over the entire period only in one of the studies.

Authors' conclusions

Programs in which physicians receive information about costs reduce medical expenditures in the short run, but their ability to produce sustained reductions in costs is unclear.

Medical costs are too high. What is the best way to reduce them? There are many ways. This article reviews six articles that examined whether providing cost informat ion could change the behavior of GPs in ordering drugs, investigative tests, and specialty services. Four of the six studies assessed sustainability of the intervention over time, and only one of these found any long-term effect. It is this lack of sustained reduction in costs that has cast doubt on any effort to solicit voluntary participation among physicians in cost reduction programs.

Similar studies have been carried out on medical specialists wi th similar findings. Cost reduction can be achieved as long as the study is carried out, but after complet ion of the experiment, most physicians, whether GPs or specialists, revert to their old (and more expensive) ways.

Why is it so diff icult to get physicians (who tend to be of above-average intelligence) to change their behavior? I believe part of the reason has to do wi th the education they receive in medical school or during their residency, where they are taught to overorder tests (lest the attending physician take them to task). It is rare that physicians in training are ever criticized for ordering too many drugs, tests or specialty services. Until this aspect of medical training is changed, it is unlikely that simple interventions wil l be able to change practices learned early in one's career. As the saying goes, old habits die hard.

Richard Howard, M o

University o f Florida Gainsvilte, Florida, USA

46 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT JUNE 1998