PHYSICIANS KNOWLEDGE OF DRUG COSTS FOR THE ELDERLY

OBJECTIVE: To measure physicians' knowledge of the costs of commonly u sed medications in geriatric practice and how such awareness influence s their prescribing decisions. DESIGN: A survey of pharmacies to deter mine the prices of 14 commonly used brand name and generic drugs and a n in-person survey of physicians asking them to price these drugs. SET TING: Eastern Massachusetts PARTICIPANTS: One hundred thirty-two prima ry care practitioners were surveyed during hospital rounds and medical society meetings. MEASUREMENT: The study examined physician awareness of patients' ability to afford drugs, the use of generic drugs, clini cal decision-making practices, and the physicians' level of knowledge of drug costs. Actual drug prices were measured by surveying 22 pharma cies. RESULTS: Of the 132 respondents, 85% reported that inability to afford medications was a problem for some of their patients. One in fi ve indicated that they did not believe generic drugs to be as safe or effective as brand name drugs, and 30% reported that they rarely or ne ver had access to information about drug costs. Of the 99 physicians w ho estimated drug prices, there was a marked trend toward underestimat ion of the prices of more expensive drugs as well as overestimation of the prices of less costly drugs. Physician estimates of prices were h ighly variable; their estimates were much more variable than pharmacy prices. Younger physicians were more likely than older physicians to m ake correct estimates, and specialists in internal medicine were less likely to make correct estimates than physicians in other specialties. CONCLUSIONS: These data indicate that substantial knowledge deficits exist in physicians' understanding of the economic implications of the prescriptions they write. Considerable educational activity will be n ecessary in this area if clinicians are to function as cost-effective prescribers under health care reform.