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Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital.
J Gen Intern Med. 2015 Mar 7;
Authors: Newman KL, Varkey J, Rykowski J, Mohan AV
Abstract
BACKGROUND: Physicians frequently prescribe antibiotics to inpatients without knowledge of medication cost. It is not well understood whether providing cost data would change prescribing behavior.
OBJECTIVE: To evaluate the association between providing cost data alongside culture and antibiotic susceptibility results and prescribing of high-cost antibiotics.
DESIGN: Quasi-experimental pre-post analysis.
PARTICIPANTS: Inpatients diagnosed with bacteremia or urinary tract infection in two tertiary care hospitals.
INTERVENTION: Cost category data for each antibiotic ($, $$, $$$, or $$) were added to culture and susceptibility testing results available to physicians.
MAIN MEASURES: Average cost category of antibiotics prescribed to patients after the receipt of susceptibility testing results.
KEY RESULTS: There was a significant decrease in the average cost category of antibiotics per patient after the intervention (pre-intervention = 1.9 $ vs. post-intervention = 1.7 $, where 1.5 $ would mean that the average number of dollar signs for antibiotics prescribed was between $ and $$, p = 0.002). After adjusting for age, insurance type, and prior length of stay, the odds ratio (OR) of a patient's average antibiotic being higher cost vs. lower cost after the intervention compared to before the intervention was 0.74 [95 % confidence interval (CI) 0.56, 0.98]. The intervention was associated with a 31.3 % reduction in the average cost per unit of antibiotics prescribed (p < 0.001).
CONCLUSIONS: Providing physicians with cost feedback alongside susceptibility testing data was associated with a significant decrease in prescription of high-cost antibiotics. This intervention is intuitive, low cost, and may shift providers toward lower cost medications when equally acceptable options are available.
PMID: 25749882 [PubMed - as supplied by publisher]