[Drug costs in reformed primary care: effect of training activities on drug savings]

Abstract

Objective: To determine the influence on drug expenditures by reformed primary care services of factors relative to the personal characteristics of prescribers, their training and training activities, their professional practice, organizational factors, and characteristics of the patient population attended.

Material and methods: This cross-sectional, observational study was carried out in the Sabadell Primary Care Directorate, Vallés Occidental region (Barcelona, Spain). This primary care directorate is responsible for the health-care needs of 9 municipalities (with a total population of 254,971 inhabitants). It has 12 Basic Health Areas, 8 of which have Primary Care Teams. The area of study included these 8 primary care teams and the unit of analysis contained 68 of 80 staff physicians. The quantitative prescription indicators (dependent variables) were: total annual drug expenditure, drug expenditure per user and year (users being understood as patients with an open medical record), drug expenditure per visit and year, mean cost per prescription, prescription/user ratio, and prescription/visit ratio. Descriptive, bivariate, and multiple linear regression analyses were made.

Results: The variables predictive of greater drug expenditures were: patient age, visits, frequentation, referrals to primary-care specialists, urban municipality, physicians with primary care and hospital practice, time on staff, and physician age. Participation in training activities was predictive of drug savings, with each primary-care training session attended producing a mean annual savings in drug expenditures of 50 ptas and 15 ptas per user and visit, respectively. Every hour dedicated to training in the community produced a savings of almost 60,000 ptas in annual drug expenditures. For each rational-drug-use session, the mean price of prescriptions decreased by 52 ptas. In the multiple linear regression models obtained, the variables that most frequently helped to explain variations between prescribers in relation to drug expenditures were: patient age, urban municipality, and primary-care-team training activities (as factors in drug savings).

Conclusions: This study confirmed that patient age, frequentation, and type of municipality increased drug expenditures. Urban municipalities, as opposed to rural or semirural municipalities, were associated with a significantly greater expense, in contrast with prevailing opinion. Our results suggested that drug expenditures increase with referrals to specialists. An interesting new finding is that physicians with simultaneous primary care and hospital practice generated more drug expenditures. Finally, we emphasize the importance of training the primary-care team in promoting drug savings (four models: drug expenditures by users, drug expenditures per visit, prescriptions per user, and prescriptions per visit), rational-drug-use activities, which tended to reduce the mean cost of prescriptions, and community training activities, which clearly reduced annual total drug expenditures.