Improving the quality and cost-effectiveness of prescribing

The 1980s witnessed the evolution of a number of programmes designed to improve the quality and economy of medication use. In the approach known as 'academic detailing', the effective communications techniques of the pharmaceutical industry are employed in the service of programmes designed to promote rational medication use, rather than to maximise sales of a particular product. Using this method, a balanced, concise presentation of the best available current research and cost literature is put into an engaging, readable format, and presented to the physician in a one-on-one interactive educational session by a pharmacist. In randomised controlled trials in 5 states, this approach has been shown to be effective in reducing inappropriate prescribing; benefit-cost analyses have shown that it generates savings that exceed programme costs. On the other hand, the 1980s also saw the implementation of several alternative approaches to changing prescribing practice, often through crude bureaucratic measures uninformed by the realities of clinical practice. Many such policies have proven to be either ineffective or counterproductive clinically and/or economically. As the issue of drug utilisation review receives increasing attention in the 1990s, it will be important to assimilate the lessons of the last 10 years to design programmes in both the public and private sectors that will enhance the quality of drug therapy while containing its costs.