An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study.

Providing feedback on cost has been demonstrated to decrease drug demand from clinicians. We conducted a prospective study with a step-wise intervention to test the hypothesis that providing information on the cost of drugs to clinicians would modify total expenditure. Participants included individuals who were admitted to the Royal Derby Hospital from -November 2013 to November 2015 under the care of physicians. The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system. The main outcome was the weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline costs. Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals [CI] -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95% CI +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95% CI -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person). New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure, but provision of feedback on drug costs resulted in no sustained change in institutional expenditure. However, clinical guidelines have the potential to modify clinical prescribing behaviour.

Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study.

We hypothesised that delays in providing non-urgent medication step-downs at weekends to medical management may be associated with increased length of stay.In a novel use of electronic prescribing data, we analysed emergency admissions from a busy acute medical hospital over 52 weeks from November 2014 to October 2015. The main outcomes of interest were switching from intravenous antibiotics to oral antibiotics and stopping nebulised bronchodilators. The rate of switching from intravenous to oral antibiotics was lower on Saturdays and Sundays compared with weekdays, and the rate of stopping nebulised bronchodilators was similarly lower at weekends (p<0.001). Median length of stay was shorter in those whose antibiotic treatment was stepped down at weekends compared with weekdays (4 days versus 5 days, p<0.001). Reduced medication step-downs at weekends may represent a bottleneck in patient flow. Electronic prescribing data are a valuable resource for future health services research.