Educational interventions affecting generic prescription
|
NRCT
|
Wensing et al., 20091818. Wensing M, Broge B, Riens B, Kaufmann-Kolle P, Akkermans R, Grol R, Szecsenyi J. Quality circles to improve prescribing of primary care physicians. Three comparative studies. Pharmacoepidemiol Drug Saf 2009; 18(9):763-769.; Germany |
PHC clinics |
Periodic meetings with physicians to inform generic prescription rates and clarify doubts; 2001 to 2003. |
3,180 physicians (Intervention 1,090; Control 2,090). |
Compared to the control group, the intervention group increased, on average, the prescription of all drugs with the possibility of prescribing the generic in 0.75% CI 95% 0.40 - 1.10]. |
Niquille et al., 20102525. Niquille A, Ruggli M, Buchmann M, Jordan D, Bugnon O. The Nine-Year Sustained Cost-Containment Impact of Swiss Pilot Physicians-Pharmacists Quality Circles. Annals of Pharmacotherapy 2010; 44(4):650-657.; Switzerland |
PHC clinics |
Continuing education on practical norms and feedback on prescriptions at meetings moderated by trained pharmacists |
24 physicians, 6 pharmacists |
The increase of each class of drug in the period was as follows: Beta-blockers (I-24.9 C-21.3); Calcium channel blockers (I- 42.1 C-43.6); Antihypertensive agents (I-7.44 C-13.6); Diuretics (I-32.2 C-37.8); Lipid-lowering agents (I-45.9 C-39.2). It does not show global data on generics. |
Rausell et al., 20051717. Rausell Rausell VJ, Tobaruela Soto M, Najera Perez MD, Iranzo Fernandez MD, Jimenez de Zadava-Lisson Lopez P, Lopez-Picazo Ferrer JJ. Effectiveness of an intervention to improve medical prescription quality in specialized care. Farmacia hospitalaria 2005; 29(2):86-94.; Spain |
Hospital |
Monthly individual reports of revenue reviews. Intervention was implemented in June 2003; monitoring occurred at 4-6 and 10-12 months following the intervention; |
94 physicians from 16 services |
There was no significant difference in the proportion of generics in the pre-intervention period p = 0.284. After 4-6 months, means were as follows: control group, 1.81% (95% CI 1.08-2.54), and intervention group, 3.13% (95% CI 1.79 - 4.47); p = 0.041. After 10-12 months, the control group showed a mean of 2.22% (95% CI 1.56-2.87) and the intervention group, 4.01% (95% CI 2.28-5.73); p = 0.025. Significant difference between groups, maintained in the two post-intervention periods. |
Walker & Mathers, 20022626. Walker J, Mathers N. The impact of a general practice group intervention on prescribing costs and patterns. Br J Gen Pract 2002; 52(476):181-186.; United Kingdom |
PHC clinics |
Pharmaceutical counseling, practical feedback, evaluative meetings, written information. Feb to May 1998. |
Intervention: 36 physicians from 9 clinics; Control: 44 physicians from 9 clinics |
Median change of 5.37% (IQR 2.56-6.32) prescriptions in the intervention group and 1.61% (IQR 1.37-4.27) prescriptions in the control group; p = 0.17. |
Calvo Alcántara & Inesta Garcia, 199933. Calvo Alcantara MJ, Inesta Garcia A. The impact of an intervention strategy in the prescription of generic drugs in a primary care area. Aten Primaria 1999; 23(7):419-424.; Spain |
PHC clinics |
Educational sessions on generics (advantages, drawbacks ...), list of selected generic drugs and reports on generic prescription; Jan 1993 to Sep 1993 (pre) Jan 1994 to Sep 1994 (During / post) |
Intervention: 24 physicians from 5 clinics Control: 24 physicians from 5 clinics |
Pre-intervention: the mean of generic drugs in the control area was 0.87 generic items / 100 thousand inhabitants (SD 0.29) and 1.07 / 100 thousand inhabitants in intervention (SD 0.51); p = 0.0923. Post-intervention: the mean of generic drugs prescribed in the control area was 0.98 / 100 thousand inhabitants (SD 0.37) and 1.61 / 100 thousand inhabitants in intervention (SD 0.81); p=0.0012. |
CBA
|
Wensing et al., 20043030. Wensing M, Broge B, Kaufmann-Kolle P, Andres E, Szecsenyi J. Quality circles to improve prescribing patterns in primary medical care: what is their actual impact? J Eval Clin Pract 2004; 10(3):457-466.; Germany |
PHC clinics |
Feedback on prescriptions and intensive program of educational sessions (n = 11) for small groups of prescribers; Apr to Jun 1998 |
177 prescribers |
Baseline: intervention group 68.3% of the prescriptions were generic and 67.4% in the control group. Post intervention: 71.1% of the prescriptions were generic in the intervention group and 68.4% in the control group. Effect of intervention was OR 1.10 (95% CI 1.08-1.13). |
Sicras Mainar & Palaez de Lono, 20053131. Sicras Mainar A, Pelaez de Lono J. Improving adequacy for drug use and effects in geriatric centers using an intervention program. Farmacia hospitalaria 2005; 29(5):303-311.; Spain |
Geriatric centers |
Letter of presentation, informative interview, monitoring of prescriptions with return of prescription information to physicians; Jan 2002 to Dec 2003 |
Intervention: 32 geriatric residences (21 and 11 in 2002 and 2003, respectively); Control: 161 geriatric residences (75 and 86 in 2002 and 2003, respectively). |
Generic prescription increased in the intervention group from 8.1% to 18.4% and from 8.3% to 14.6 in the control group. Year-on-year growth of 127.2% for the intervention group and 75.9% for the control group (p <0.001) |
ITS
|
dLopez-Picazo Ferrer et al., 20023232. Lopez-Picazo Ferrer JJ, Sanz Moreno JA, Bernal Montanes JM, Sanchez Ruiz JF. Evaluating, improving and monitoring generic drug prescription. Aten Primaria 2002; 29(7):397-406.; Spain |
PHC clinics |
Monthly report on the pattern of generic prescription; half-yearly letters updating the printed list of generic drugs; dissemination and discussion sessions on the results achieved; Oct 1998 to Mar 2000. |
339 physicians from 45 teams |
Prescription of generics increased from 2.79% in the pre-intervention period to 17.63% in post-intervention. The absolute increase was 14.84% and the relative increase was 15.27%. Before the intervention, mean of prescriptions by generic name was 3.12%; during the intervention, it was 11.9%; and after the intervention, it increased to 20.25%. |
Educational interventions affecting the pharmacist in the replacement of reference medicines with generic drugs
|
RCT
|
Knowlton & Knapp, 19943333. Knowlton CH, Knapp DA. Community pharmacists help HMO cut drug costs. American pharmacy 1994; 34(1):36-42.; USA |
Community pharmacies |
Workshop for pharmacists to intervene in the choice between branded or generic medicines; Apr to Dec 1991 |
Intervention: 9 pharmacists; Control: 9 pharmacists; Comparison: 9 pharmacists |
The average replacement rate of generic drugs in the intervention group pharmacies was 6.34% higher compared to control pharmacies (35.83% vs. 29.45%, p <0.05). |
Educational interventions affecting the prescription of reference drugs
|
CBA
|
Mastura & Teng, 20081616. Mastura I, Teng CL. The effect of “group detailing” on drug prescribing in primary care. Med J Malaysia 2008; 63(4):315-318.; Malaysia |
PHC clinics |
Meetings for detailed information on prescription by generic name; March to Apr. 2004 |
Two clinics; 9 offices (5 intervention and 4 control); 3,371 prescriptions |
Significant reduction of prescription of drugs by reference name comparing the pre- and post-intervention phases. Reduction from 33.9% to 19.0%, representing a 44% reduction (post-intervention RR of 0.56; 95% CI 0.48-0.66). |
Educational interventions affecting user’s replacement of reference medicines with generic drugs
|
NRCT
|
Sedjo & Cox, 20093535. Sedjo RL, Cox ER. The influence of targeted education on medication persistence and generic substitution among consumer-directed health care enrollees. Health Services Research 2009; 44(6):2079-2092.; USA |
Health plan |
Receiving messages encouraging treatment adherence and increasing awareness on the low cost of the generic alternative; 2007 |
Intervention: 904 plan members; Control: 1,409 members |
Those who received educational intervention were more likely to replace with the lower cost generic antihypertensive (ACEI) (ORadj = 29.82, 95% CI 4.41-201.93) and there was no difference for users of antidepressants and lipid-lowering agents. |
Financial incentives affecting generic prescription
|
RCT
|
Bhargava et al., 20103636. Bhargava V, Greg ME, Shields MC. Addition of generic medication vouchers to a pharmacist academic detailing program: effects on the generic dispensing ratio in a physician-hospital organization. J Manag Care Pharm 2010; 16(6):384-392.; USA |
PHC clinics |
Intervention: Receipt of generic drug voucher + folder with generic drug information; Control: folder only; Jul. 2007 to Mar. 2008 |
21 clinics (10 intervention x 11 control) participated |
The generic dispensing rate for all drugs increased by 7.4 percentage points (p.p.) in the intervention group (53.4% to 60.8%) and 6.2 percentage points in the control group (55.9% to 62.1%). The estimated effect of the voucher is an increased generic dispensing rate of 1.77 p.p. (p = 0.047) |
ITS
|
dLopez-Picazo Ferrer et al., 20023232. Lopez-Picazo Ferrer JJ, Sanz Moreno JA, Bernal Montanes JM, Sanchez Ruiz JF. Evaluating, improving and monitoring generic drug prescription. Aten Primaria 2002; 29(7):397-406.; Spain |
PHC clinics |
Monthly report on the pattern of generic prescription; half-yearly letters updating the printed list of generic drugs; dissemination and discussion sessions on the results achieved; and financial incentive for each prescriber to achieve those goals; Oct 1998 to Mar 2000. |
339 physicians from 45 teams |
Prescription of generics increased from 2.79% in the pre-intervention period to 17.63% in post-intervention. Absolute increase was 14.84% and the relative increase was 15.27%. Prior to intervention, the mean of prescriptions by generic name was 3.12%; during intervention, 11.9% and after the intervention, 20.25%. |
CBA
|
Scott et al., 20073737. Scott AB, Culley EJ, O’Donnell J. Effects of a physician office generic drug sampling system on generic dispensing ratios and drug costs in a large managed care organization. J Manag Care Pharm 2007; 13(5):412-419.; USA |
PHC clinics |
Implementation of automated generic sample supply system supplemented by detailed information (on co-payment, evidence-based information on replacement, chemical equivalence and patent expiry); 2003 to 2006. |
2005: 64 clinics and 301 prescribers; 2006: 168 clinics and 631 prescribers |
Baseline Measures: dispensed Generic drug rate (DGR) was 47.8% in both groups. After the first year, DGR had an absolute increase of 7.5 p.p. (from 47.8 to 55.3%) in the intervention group, and 6.3 p.p. (47.8% to 54.1%) in the control group. The absolute difference between the participant and nonparticipant groups in the first year of follow-up was 1.2 p.p. In the second year, the difference fell to 0.8 p.p. (59.9% for the intervention group and 59.1% in the control group). |
Financial incentives affecting user’s use of generics over reference drugs
|
CBA
|
Dunn et al., 200644. Dunn JD, Cannon E, Mitchell MP, Curtiss FR. Utilization and drug cost outcomes of a step-therapy edit for generic antidepressants in an HMO in an integrated health system. J Manag Care Pharm 2006; 12(4):294-302.; USA |
Health Plan’s Mental Health Clinics |
Introduction of a “Generic Start! Program” with financial incentives to generics in the “3-tiered” co-payment system; Jan. 2004 to Dec 2005 |
Intervention: 440 thousand HMO members; Control: 500 thousand HMO members |
Prescription of generics increased 20 p.p. (32.5% to 52.5%) in the intervention group and 7.4 p.p. in the control group (24.9 to 32.3%) between 2004 and 2005, with a relative increase of 61.5% in the intervention group and 29.7% in the control group. |
Electronic prescription affecting user’s use of generics over reference drugs
|
CBA
|
Fischer et al., 20143838. Fischer MA, Vogeli C, Stedman M, Ferris T, Brookhart MA, Weissman JS. Effect of electronic prescribing with formulary decision support on medication use and cost. Arch Intern Med 2008; 168(22):2433-2439.; USA |
University Medica Center |
Electronic prescription that brings the generic to prominence; Oct 2003 to Mar 2004 |
Intervention: 35,651 physicians; Control: 1,198 physicians |
Generic equal to “Tiers 1”. Baseline: the proportion of generic prescriptions was 53.2% in the intervention group and 54.8% in the control group. After the intervention: 61.4% of electronic prescriptions were generic, representing a 6.6% increase in the generic prescription rate (95% CI 5.9%-7.3%) compared to a 2.6% increase (95% CI 2.5-2.7%) in the control group. |
ITS
|
Stenner et al., 20103939. Stenner SP, Chen Q, Johnson KB. Impact of generic substitution decision support on electronic prescribing behavior. J Am Med Inform Assoc 2010; 17(6):681-688.; USA |
Hospital |
Electronic prescription that brings the generic to prominence; Jul 2005 to Sep 2008. |
Over de 1.1 million electronic prescriptions |
The proportion of generic drugs increased after the intervention, from 32.1% to 54.2% (an increase of 22.1% 95% CI 21.9%-22.3%). In the control group, the proportion of generic prescriptions was 29.3%, 31.4% and 37.4% in the pre-intervention, post-intervention and final study periods, respectively). |
Managerial Reform affecting user’s use of generics over reference drugs
|
CBA
|
Bradlow & Coulter, 19934040. Bradlow J, Coulter A. Effect of fundholding and indicative prescribing schemes on general practitioners’ prescribing costs. BMJ 1993; 307(6913):1186-1189.; United Kingdom |
Medical clinics |
Reform in the NHS (introduction of budget ceiling for prescribers); 1990/1 - phase 1; 1991/2 - phase 2 |
Intervention: fixed-budget clinics; Control: clinics without a fixed budget. |
The percentage of generic drugs prescribed in the two phases of the study Phase 1 - with a dispensing budget ceiling: 26.9%. Without a non-dispensing budget ceiling: 46.5%. Phase 2 - Fixed dispensing budget - 34.5% [increased 7.6% (95% CI 7.2 - 8.0)] and control - 46.6% [increased 0.1% (95% CI 0.2-0.4)]. |