title: Changing physician prescribing behavior: a low-cost administrative policy that reduced the use of brand name nonsteroidal anti-inflammatory drugs.
abstract: BACKGROUND
  In the United States, expenditures for prescription drugs are rapidly rising. There is concern that physicians do not prescribe medications in the most cost-saving manner. The objective of this study was to determine if a low-cost administrative intervention would decrease the use of brand name nonsteroidal anti-inflammatory drugs (bnNSAIDs).
  
  
  METHODS
  A before-after trial of an administrative intervention to change prescribing behavior at an urban public hospital and its satellite clinics was performed. We evaluated all filled NSAID prescriptions, a total of 127,925, over an 8.5-month period before and after the intervention. The intervention requested physicians to complete a short form listing two generic name nonsteroidal anti-inflammatory drugs (gnNSAIDs) that the patient had already tried if they wished to prescribe a bnNSAID.
  
  
  RESULTS
  During the 8.5 months before any intervention, 10.5% of 65,404 NSAID prescriptions were written as brand name prescriptions. For the 8.5 months during the intervention, physicians wrote 62,521 NSAID prescriptions, of which 6.9% (4,322/62,521) were brand name. This represents a 34% decrease in bnNSAID prescriptions (P < 0.0001). Using the average pharmacy acquisition costs for bnNSAIDs and gnNSAIDs, as well as the percentage of decrease in bnNSAID use, we calculated the cost savings to the institution to be $92,914 for the 8.5 months, or a projected annualized savings of $131,172. The decline in bnNSAID prescriptions was site specific; settings in which house staff were supervised by attending physicians had a greater decline when compared to community-based primary care physicians (P < 0.05).
  
  
  CONCLUSIONS
  A low-cost administrative intervention can have a significant impact on physicians' prescribing habits of NSAIDs and result in cost savings to the institution.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Ahluwalia
authors.forename: M L
authors.initials: ML
authors.lastname: Weisenberger
authors.forename: A M
authors.initials: AM
authors.lastname: Bernard
authors.forename: S E
authors.initials: SE
authors.lastname: McNagny
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics*; D016009:Chi-Square Distribution; D017046:Cost Savings / Q000379:methods / Q000706:statistics & numerical data*; D016568:Drugs, Generic / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics* / Q000379:methods; D006801:Humans; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016568:Drugs, Generic