Ruggli M. 1 , Nyffeler R. 3 , Duay B. 4 , Repond C. 4 , Buchmann M. 4 , Bugnon O. 1;2

1. Efficiency improvement of primary care prescription by physicians - pharmacists cooperating in quality circles Ruggli M.1, Nyffeler R. 3, Duay B.4, Repond C.4, Buchmann M. 4, Bugnon O.1;2 1 Swiss Association of Pharmacists, Liebefeld, Switzerland 2 Community Pharmacy of the University Medical Outpatient Clinic, Lausanne, Switzerland 3 Medical Association of Primary Care Physicians, Fribourg, Switzerland 4 Pharmaceutical Association of Pharmacists, Fribourg, Switzerland Contact address: Martine.Ruggli@sphin.ch Schweizerischer Apothekerverband Société Suisse des Pharmaciens Società Svizzera dei Farmacisti AIMS OF THE STUDY: In 1997 the Medical and Pharmacist's associations of Fribourg, Switzerland, launched a pilot project of cooperation between physicians and pharmacists: 6 pharmacists each coached a quality circle with a total of 27 physicians. The circles worked on 17 therapeutic groups comparing the risk/benefit of drugs, discussing prescribing patterns and trying to agree on treatment options based on two objectives: improving the quality and efficiency of care. After the encouraging results reported in 1999 and 2000 1, the new assessment is based on the years 1999 to 2002. Work processContinous quality improvement of prescription CONCEPT OF PHYSICIANS-PHARMACISTS QUALITY CIRCLES: The quality circles are stable groups of 4 to 10 physicians with one (or more) pharmacist as moderator. Based on the physicians’own current prescription data, pharmacists and physicians are involved in the continuous quality improvement of prescribing practices, thanks to education on guidelines, evidence-based medicine and pharmacoeconomy. 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 6.Check on the impact of the consensus 5.Application of the consensus 3.Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market RESULTS: During these 4 years the overall cost of drugs increased by 39% in the control group (80 comparable general practitioners, but not involved with pharmacists in quality circles) and 30% in the 6 circles (figure 1) 4.Consensus of each quality circle In 2002 this 9% increase differencerepresents asaving of about 48’000 CHF per physician (circa $ 37’000.- in August 2004) Fig. 1 cost evolution between 1999 and 2002 for quality circles and control group • The physicians working with pharmacists changed their prescription patterns in a lasting way, as can been seen in 2002: • More reasonable influence of marketing and advertising: less coxibs (10.5 vs 17.3%), A2A (23.8 vs 29.4%) or glitazones (3.5 vs 5.2%) (fig 4). • Qualitatively more adapted frequency of prescription: lower for antibiotics (25.2 vs 28.4%) and NSAIDS (37.8 vs 40.1%) (fig3) • Higher rate of generics prescription (42 vs 25% for antibiotics, 47 vs 22% for NSAIDs) (fig 2) A2A NSAIDS ANTIBIOTICS COXIBS ANTIBIOTICS NSAIDS GLITAZONES Fig. 2 Generics prescription for antibiotics and NSAIDS Fig. 4 : Proportion of prescribedcoxibs, A2A and glitazones Fig. 3 Prescription frequency of antibiotics and NSAIDS CONCLUSIONS: This study confirmed the added value of physicians-pharmacists quality circles as local care managing projects for the improvement of drug prescription efficiency.Quality circles at a local level succeed in promoting the use of evaluated generics and other cost- and outcome-effective activities including evidence-based analyses of new drugs, interdisciplinary continuing education on the rational use of drugs, implementation at a local level of national or international guidelines, continuing and comparative follow-up of the consensus implementation. Community pharmacists can influence physicians’ attitudes and are efficient partners in care management. The project has now disseminated throughout Switzerland and has been acknowledged by politicians and major private insurers. A financial incentive was granted for the pilot project and a national negotiation started in 2004. REFERENCES 1Increase of generics prescription by physicians involved with pharmacists in quality circles, O. Bugnon, I. Gremaud-Tinguely, C. Repond, J. Carrel, D. Muscionico, R. Nyffeler and M. Buchmann, FIP 2000