Prescribing, prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care

Background: In southern Sweden, many general practitioners (GPs) participat e in an extensive postgraduate drug education programme, and many health ce ntres are also fed back crude local drug statistics from pharmacists in the area. Private physicians and hospital physicians have not participated in these programmes. Objective: The drug prescribing habits and costs of GPs, hospital physician s and private physicians were compared. Methods: Each March: from 1990 to 1997, all prescriptions dispensed at the eight pharmacies in Vaxjo, a city and municipality in southern Sweden, were registered, specifying drug(s) prescribed, price, patient's age, sex and a rea of residence, and prescriber's place of work and category. Results: Overall, the costs of prescribed drugs increased with time, even i n 1997 when the prescribing volume was reduced due to changes in the reimbu rsement system. The cost increase was caused by increased prescribing of ne wer, more expensive drug alternatives. However, within each of the eleven m ajor drug groups, the drugs prescribed by GPs were loss expensive than thos e prescribed by hospital physicians and, particularly, private physicians. Moreover, even though GPs prescribed more and a wider range of drugs, they also had a higher degree of adherence to the recommendations by the formula ry committee. Conclusion: GPs prescribed less expensive drugs and had a higher degree of adherence to the recommendations by the formulary committee than other cate gories of physicians. One reason for these differences may be that the GPs participated in regional and local educational activities aimed at the rati onalisation of drug prescribing.