gms | German Medical Science

Background: Growing therapeutic possibilities, e. g. due to drug development, lead to continuously increasing costs. Provided that the quality of therapy is guaranteed, rising costs for pharmaceuticals require that any potential for savings with regards to drug prescriptions is utilized in an optimal way. There are already political and economic tools in place for controlling regulations to that effect, e. g. the early assessment of drugs according to § 35a SGB V [1]. In contrast to legally consolidated specifications or certain rates which are within the framework of contracts, pharmaceutical advice for doctors should not only follow a juristic/economic approach, but also a scientific approach. Therefore, the aim of our intervention is to reduce inappropriate drug prescriptions through evidence-based knowledge and targeted communication of noticeable doctors, taking into account the results of studies and recommendations for guidelines. Thus, costs would be reduced with the patients' interest at heart by promoting evidence-based prescriptions and drug therapy reliability.

Materials and Methods: The current literature is carefully screened for new findings on drugs. Medication- and prescription-related issues implicating a critical approach due to insufficient therapeutic effects and thus inappropriate drug expenses are identified.

For this purpose, prescription data of the Techniker Krankenkasse (TK) are analyzed in terms of noticeable peculiarities regarding the relevant issue. Doctors who are possibly too uncritical in their approach to prescribing medication are systematically identified. Afterwards a cover letter is created and sent by postal delivery in order to announce a phone call that will address the issue. The telephone calls are conducted by people with as well as without a pharmaceutical background, but always following a specified guideline for counseling.

Professionals who do not have any specific medical or pharmaceutical knowledge are trained before the intervention with regards to the essential facts of issue in order to achieve a definite level of professional competence. The topic of interest is then addressed in a personal conversation by phone with the identified doctors, and specific questions can be answered immediately. In the event that a specific question cannot be answered directly due to the lack of pharmaceutical expert knowledge, the call is forwarded to a pharmacist.

Finally, the main outcome measure is the comparison of prescription behavior of selected doctors before and after the intervention, quantified by the change in prescription numbers or frequency.

Results: Subjective impression, e. g. of our latest intervention concerning the critical use of ezetimibe, already reveals that some doctors appreciate the individual conversation within the context of science. Furthermore, it shows that the personal conversation enables doctors to inform about day-to-day issues in contrast to hypothetical concepts, thus providing a full picture. The intervention also demonstrates that people without a specific pharmaceutical background, but instead specific training regarding the key point of issue, are able to achieve positive results in terms of the intervention. However, at this particular time, we are still in the process of evaluating.

Conclusion: Overall, our previous experience shows that an individual conversation is successful with regards to drug prescription and an increased awareness of evidence-based medication as well as drug therapy reliability. Some of the doctors particularly appreciate the scientific approach to addressing issues. Nonetheless, the final results of the evaluation are needed to verify the suspected positive effect of this intervention.