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Dispensing Doctors were found to prescribe greater numbers of drugs

Decreased Inappropriate Antibiotic Use Following a Korean National Policy to Prohibit Medication Dispensing by Physicians. Sylvia Park, Stephen B. Soumerai, Alyce S. Adams, Jonathan A. Finkelstein, Sunmee Jang*, Dennis Ross-Degnan

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Dispensing Doctors were found to prescribe greater numbers of drugs

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  1. Decreased Inappropriate Antibiotic Use Following a Korean National Policy to Prohibit Medication Dispensing by Physicians Sylvia Park, Stephen B. Soumerai, Alyce S. Adams, Jonathan A. Finkelstein, Sunmee Jang*, Dennis Ross-Degnan Harvard Medical School, USA. *Health Insurance Review Agency, Korea

  2. Research on Dispensing Doctors • Dispensing Doctors were found to • prescribe greater numbers of drugs • prescribe more antibiotics and injections • have higher prescribing costs • Little is known about quality of prescribing • Cross-sectional research

  3. Dispensing Policy and Antibiotic Use in Korea • New policy (July 2000) • prohibiting doctors from dispensing drugs and pharmacists from prescribing drugs • Antibiotic Use • most commonly used drugs – 20% of ambulatory drug expenditures (2000) • overused and inappropriately used • high resistance rate - 86% of Streptococcus pneumoniae resistant to penicillin (2001)

  4. Objects • To evaluate the impact of the new policy in Korea on the quantity and quality of physician prescribing • selectivity in the decrease of antibiotic prescribing in viral and bacterial illness • To investigate provider characteristics related to the decrease of inappropriate antibiotic prescribing in viral illness

  5. New Policy (Jul. 2000) Jan. 2000 Jan. 2001 Korean National Health Insurance monthly claims data Viral Illness Group : Common Cold / URI / Bronchiolitis Bacterial Illness Group : Penumonia/ Otitis media/ Tonsilitis/ Strep. Sore throat/ Sinusitis/ UTI/ SST 10% clinics, 20% cases No commorbidity 50,999 Cases (1,372 clinics) Prescription Analysis • -Antibiotics (antibiotic prescribing/ # of different antibiotics) • Non-antibiotic Drugs (GI drug prescribing/ # of non-antibiotic drugs)

  6. Characteristics of Cases

  7. Impact of the Policy on Prescribing • Generalized Estimating Equations Y= ß0 + ß1×Policy+ ß2×Illness + ß3×Policy×Illness (+ ß4 Patient or provider char. + ß5 … ) +  - Y: Prescription Variables(patient level) - X: Policy: after policy=1 / before policy=0 : Illness: viral=1 / bacterial=0 : Policy×Illness: Interaction (different policy effect between illnesses) : Patient or provider characteristics : gender, age, location, size, type - Cluster effect : clinic

  8. Impact of the Policy on Prescribing • Antibiotic Prescribing

  9. Impact of the Policy on Prescribing • Number of Different Antibiotics

  10. Impact of the Policy on Prescribing • Gastrointestinal Drug Prescribing • Number of Different Non-antibiotic Drugs

  11. Provider Characteristics Related to Decrease of Inappropriate Antibiotic Prescribing • Multiple Regression – Clinic level Y= ß0 + ß1Location + ß2Type + ß3Size (+ ß4Age + ß5Gender) +  • Y: Antibiotic prescribing rate(baseline & change) : Average # of different antibiotics per case(baseline & change) (age, gender, diagnosis mix adjusted) • X: Location : Urban / Rural Type : Group / Solo Size : <= 150 pt / 151 - 250 pt / >= 251 pt Age : <= 39 / 40 - 49 / >= 50 Gender : Male / Female

  12. Provider Characteristics Related to Decrease of Inappropriate Antibiotic Prescribing

  13. Test on Changes in Diagnostic Coding • Bacterial or possibly bacterial diagnoses did not increase as either primary or secondary diagnosis. (primary: 52.2% -> 51.4%; secondary: 33.7% -> 33.6%) Pre-intervention Trends of Prescribing • Antibiotic prescribing rate for URI had hardly changed before study period. : 1994 – 2000 : 85.6% -> 88.7% (adults) / 90.6% -> 89.0% (children) • In viral illness, it dropped after the policy (80.8 % -> 72.8%). • Number of drugs per case with URI in 1994 was same as that for viral illness cases before the policy in the study (5.1) • It dropped after the policy. • GI drug prescribing had increased in 1997-2000 • It dropped after the policy.

  14. Conclusions • Prohibiting doctors from dispensing drugs reduced prescribing overall, both antibiotics and other drugs, and selectively reduced inappropriate antibiotic prescribing for patients with viral diagnosis. • Still high rate of antibiotic prescribing for viral illness after policy indicates the need for further targeted interventions • Further study using longitudinal data is needed to evaluate whether these reductions in prescribing and improvements in quality are maintained.

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