Friday, December 26, 2008

Decision Suuport and Drug Choice

A recent article in the Archives of Internal Medicine by Michael A. Fischer, Christine Vogeli, Margaret Stedman, Timothy Ferris, M. Alan Brookhart and Joel S. Weissman (all at either the Brigham or Mass General Hospitals in Boston) looked at the effect of simple clinical decision support on prescribing habits. The intervention was simply providing the prescriber with information about the patient's medication insurance coverage at the time of prescribing. After the formulary decision support was turned on, low cost prescriptions (generics or "Tier 1" drugs) went up 3.3%. This resulted in an estimated savings of $8.45 per patient per year! The remarkable and optimistic finding is that they saw these savings with only 12% of the prescriptions getting the decision support.

Caveats - this was not a randomized trial, so it is hard to be sure that the savings were not due to some other factor. Also, the costs of the decision support system may not have been included in the savings calculation.

Nonetheless, this report suggests that even systems that are not very sophisticated (this one doesn't seem to have any clinical acumen - it just looks up the formulary) can have a beneficial effect.

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