A simple institutional educational intervention to decrease use of selected expensive medications

Objective: To determine whether a simple educational intervention can influ ence use of prescription medications at an institution Design: Cost-effectiveness analysis of prescribing behavior before and afte r an educational intervention. Setting: A large, urban, free-standing academic rehabilitation hospital. Participants: Physicians, residents, and physician extenders. Interventions: The hospital's pharmacy department provided simple written e ducational material about cost differences of various prescription medicati ons to attending and resident physicians, nurse leaders, and case managers. Telephoned reminders were given when targeted medications were prescribed. Main Outcome Measures: Total prescription medication use was recorded month ly for 12 months before and after the intervention. Pharmaceuticals monitor ed were subcutaneously administered anticoagulants, histamine type 2 (H2) b lockers, and nonsteroidal anti-inflammatory drugs (NSAIDs). Results: A 32% decrease in use of the more costly anticoagulant and a 20% i ncrease in use of the less costly anticoagulant (p <.0001), representing an estimated annual savings of nearly $66,000. Use of more costly H2 antagoni st decreased 50% and use of less costly H2 antagonist increased 128% (p <.0 001). With written intervention only, use of more costly NSAIDs declined 28 %, whereas use of less costly NSAIDs increased 58% (p <.0020). Conclusion: Providing physicians with simple pharmaceutical cost informatio n and telephone reminders decreased the use of targeted more costly medicat ions.