Abstract
OBJECTIVE: To determine the effectiveness of an educational intervention designed to improve physicians’ knowledge of drug costs and foster willingness to consider costs when prescribing.
DESIGN: Pre- and post-intervention evaluation, using physicians as their own controls.
SETTING: Four teaching hospitals, affiliated with 2 residency programs, in New York City and northern New Jersey.
PARTICIPANTS: One hundred forty-six internal medicine house officers and attendings evaluated the intervention (71% response rate). Of these, 109 had also participated in a pre-intervention survey.
INTERVENTION: An interactive teaching conference and distribution of a pocket guide, which listed the average wholesale prices of over 100 medications commonly used in primary care
MEASUREMENTS AND MAIN RESULTS: We administered a written survey, before and 6 months after the intervention. Changes in attitudes and knowledge were assessed, using physicians as their own controls, with Wilcoxon matched-pairs signed-rank tests. Eighty-five percent of respondents reported receiving the pocket guide and 46% reported attending 1 of the teaching conferences. Of those who received the pocket guide, nearly two thirds (62%) reported using it once a month or more, and more than half (54%) rated it as moderately or very useful. Compared to their baseline responses, physicians after the intervention were more likely to ask patients about their out-of-pocket drug costs (22% before vs 27% after; P<.01) and less likely to feel unaware of drug costs (78% before vs 72% after; P=.02). After the intervention, physicians also reported more concern about the cost of drugs when prescribing for patients with Medicare (58% before vs 72% after; P<.01) or no insurance (90% before vs 98% after; P<.01). Knowledge of the costs of 33 drugs was more accurate after the intervention than before (P<.05).
CONCLUSION: Our brief educational intervention led to modest improvements in physicians’ knowledge of medication costs and their willingness to consider costs when prescribing. Future research could incorporate more high-intensity strategies, such as outreach visits, and target specific prescribing behaviors.
Similar content being viewed by others
References
Iglehart JK. Medicare and prescription drugs. N Engl J Med. 2001;344:1010–5.
Iglehart JK. The American health care system—Expenditures. N Engl J Med. 1999;340:70–6.
Pear R. Budget office’s estimates for drug spending grow: adding to challenge of Medicare coverage. New York Times. February 24, 2001:A7.
Davis M, Poisal J, Chulis G, Zarabozo C, Cooper B. Prescription drug coverage, utilization, and spending among Medicare beneficiaries. Health Aff (Millwood). 1999;18:231–43.
Mehl B, Santell J. Projecting future drug expenditures—2001. Am J Health Syst Pharm. 2001;58:125–33.
Soumerai SB, Ross-Degnan D. Inadequate prescription-drug coverage for Medicare enrollees—A call to action. N Engl J Med. 1999;340:722–8.
Etheredge L. Purchasing Medicare prescription drug benefits: a new proposal. Health Aff (Millwood). 1999;18:7–19.
Pear R. Spending on prescription drugs increases by almost 19 percent: doctors are using more of costliest medicines. New York Times. May 8, 2001:A1, A16.
Reichert S, Simon T, Halm EA. Physicians’ attitudes about prescribing and knowledge of the costs of common medications. Arch Intern Med. 2000;160:2799–803.
Beringer GB, Biel M, Ziegler DK. Neurologists’ knowledge of medication costs. Neurology. 1984;34:121–2.
Fowkes FG. Doctors’ knowledge of the costs of medical care. Med Educ. 1985;19:113–7.
Glickman L, Bruce EA, Caro FG, Avorn J. Physicians’ knowledge of drug costs for the elderly. J Am Geriatr Soc. 1994;42:992–6.
Hoffman J, Barefield FA, Ramamurthy S. A survey of physician knowledge of drug costs. J Pain Symptom Manage. 1995;10:432–5.
Miller LG, Blum A. Physician awareness of prescription drug costs: a missing element of drug advertising and promotion. J Fam Pract. 1993;36:33–6.
Oppenheim GL, Erickson SH, Ashworth C. The family physician’s knowledge of the cost of prescribed drugs. J Fam Pract. 1981;12:1027–30.
Rowe J, MacVicar S. Doctors’ knowledge of the cost of common medications. J Clin Hosp Pharm. 1986;11:365–8.
Ryan M, Yule B, Bond C, Taylor RJ. Scottish general practitioners’ attitudes and knowledge in respect of prescribing costs. BMJ. 1990;300:1316–8.
Walzak D, Swindells S, Bhardwaj A. Primary care physicians and the cost of drugs: a study of prescribing practices based on recognition and information sources. J Clin Pharmacol. 1994;34:1159–63.
Weber ML, Auger C, Cleroux R. Knowledge of medical students, pediatric residents, and pediatricians about the cost of some medications. Pediatr Pharmacol (New York). 1986;5:281–5.
Top 200 brand-name Rx drugs. In: Cardinale V, ed. 1998 Drug Topics Red Book. Montvale, NJ: Medical Economics Co.;1998:130.
Top 200 generic Rx drugs. In: Cardinale V, ed. 1998 Drug Topics Red Book. Montvale, NJ: Medical Economics Co.;1998:131.
Abramowicz M. ed. The Medical Letter: On Drugs and Therapeutics. New Rochelle, NY, Feb. 1995 – Aug. 1998.
Cardinale V, ed. 1998 Drug Topics Red Book. Montvale, NJ: Medical Economics Co.;1998.
Rosner B. Fundamentals of Biostatistics, 5th ed. Pacific Grove, Calif: Duxbury; 2000.
Salman H, Bergmann M, Hart J, et al. The effect of drug cost on hypertension treatment decision. Public Health. 1999;113:243–6.
Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995;274:700–5.
Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39:II2–45.
Grol R. Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286:2578–85.
Thomson O’Brien MA, Freemantle N, Oxman AD, Wolf F, Davis DA, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library, Issue 2. Oxford: Update Software; 2002.
ePocrates Rx. version 4.0. Available at: http://epocrates.com. Accessed September 23, 2002.
Pocket Pharmacopeia software. Available at: http://tarasonpublishing.com/store/palm.asp. Accessed September 23, 2002.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Korn was a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the time this project was completed. Dr. Halm is supported in part by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. Funding for the educational intervention was provided by the Department of Medicine, Mount Sinai School of Medicine, New York, NY. The authors have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Korn, L.M., Reichert, S., Simon, T. et al. Improving physicians’ knowledge of the costs of common medications and willingness to consider costs when prescribing. J GEN INTERN MED 18, 31–37 (2003). https://doi.org/10.1046/j.1525-1497.2003.20115.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2003.20115.x