Pharmaceutical donations by the USA: an assessment of relevance and time-to-expiry.

This paper assesses the relevance and time-to-expiry of pharmaceutical donations by the USA by means of a convenience sample of two private voluntary organizations. Data were collected on 16,566 donations shipped between 1994 and 1997 for the two organizations to a total of 129 countries. For three field study countries (Armenia, Haiti, and the United Republic of Tanzania), between 37% and 65% of donated unique drug products were on the recipient countries' essential drugs lists, and between 50% and 80% were either on these lists or were permissible therapeutic alternatives. Between 10% and 42% were not listed on either the national essential drugs lists or the WHO Model List of Essential Drugs, nor were they permissible therapeutic alternatives. For the worldwide data set, the median times to expiry when shipment by the organizations took place were 599 and 550 days; about 30% of shipment items had a year or less of shelf-life, and about 6% had less than 100 days of shelf-life. Although a majority of the donations fulfilled the criteria of relevance and time-to-expiry, a substantial proportion failed to do so. Actions are proposed with a view to improving the relevance and time-to-expiry of USA pharmaceutical donations.

A successful experiment to reduce unnecessary laboratory use in a community hospital.

A series of interventions at a 228-bed general hospital provided physicians with feedback at regular intervals concerning the amount of laboratory services employed in treating their patients. Case-mix-adjusted estimates of laboratory tests allowed each physician to compare use of laboratory tests with that of peers in the same department at the same hospital. Physicians with "excess" practice patterns ordered hundreds more laboratory tests than average each year. A multifaceted educational program included the following: 1) meetings were held concerning costs and unnecessary laboratory tests; 2) physicians were given descriptions of their practice patterns relative to their peers as part of both large and small departmental discussions; 3) the feedback was repeated a year later; 4) a consensus conference established guidelines for test ordering; and 5) a sample of patient records was examined for appropriateness of laboratory test ordering. A total of 37% of a sample of tests ordered during the baseline period by physicians with "excess" practice patterns was classified as inappropriate. The intervention resulted in a reduction of 1.8 tests per patient (P = 0.0005). Eight of the nine tests individually showed reductions in use. Charge data from the target hospital showed a statistically significant reduction in laboratory charges per patient in the quarter following program initiation (P = 0.02) and no evidence for change in a group of five comparison hospitals. There was no evidence for reductions in the ordering of essential tests. These results demonstrate a cost-effective approach to reducing unnecessary costs that can be implemented in hospitals with integrated data systems.