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Can Physician Education Lower the Cost of Prescription Drugs?: A Prospective, Controlled Trial

Linda M. Frazier, MD; J. Trig Brown, MD, MPH; George W. Divine, PhD; Gayle R. Fleming, RPh; Nancy M. Philips, MD; William C. Siegal, MD, MPH; and Moise A. Khayrallah, MA
[+] Article, Author, and Disclosure Information

Presented at the national meeting of the Society for General Internal Medicine, Washington, DC on 26 April 1989 and the national meeting of the Association of Program Directors in Internal Medicine, Boston, MA on 30 November 1989.

Grant Support: In part by a grant from the Kate B. Reynolds Health Care Trust.

Requests for Reprints: Linda M. Frazier, MD, Box 2914, Duke University Medical Center, Durham, NC 27710.

Current Author Addresses: Dr. Frazier: Box 2914, Duke University Medical Center, Durham, NC 27710.

Dr. Brown: Box 3824, Duke University Medical Center, Durham, NC 27710.

Dr. Divine: Box 3040, Duke University Medical Center, Durham, NC 27710.

Ms. Fleming: Box 3089, Duke University Medical Center, Durham, NC 27710.

Dr. Philips: Community Health Center, 2 Maynard Street, Hanover, NH 03755.

Dr. Siegel: New England Deaconess Hospital, 185 Pilgrim Road, Boston, MA 02215.

Mr. Khayrallah: School of Education, Peabody Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514.

©1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(2):116-121. doi:10.7326/0003-4819-115-2-116
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▪ Objective: To determine whether an educational program featuring a drug cost manual can assist physicians in reducing their patients' out-of-pocket prescription drug expenses.

▪ Design: Prospective controlled trial.

▪ Setting: A general internal medicine-teaching clinic in a university hospital.

▪ Participants: Fifty-one medical interns.

▪ Intervention: Thirty-one interns received a manual of comparative drug prices annotated with prescribing advice, two feedback reports, and weekly cost-oriented prescribing reminders. A control group concurrently participated in a manual-based educational program on cholesterol management.

▪ Measurements: Copies of 3012 prescriptions written over 8 months were analyzed.

▪ Main Results: Intervention group physicians prescribed less expensive drugs within classes of drugs. The change in drug price score per prescription was - 0.15 (95% Cl, - 0.27 to - 0.04; P = 0.01). A score of 3 was assigned to the most expensive, 2 was assigned to intermediate-priced, and 1 was assigned to the least expensive drug or drugs in the class. An increase of 0.74 months' (Cl, 0.49 to 0.98; P < 0.001) supply of medication was dispensed per prescription, reducing dispensing fees. The program was well accepted by the physicians.

▪ Conclusion: This relatively simple educational intervention can help physicians to reduce their patients' drug expenses and may serve as a model for incorporating cost information into the routine practice of medicine.





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