Physicians' perceptions about managed care restrictions on antibiotic prescribing

Area of Science:

• Health Services Research
• Medical Economics
• Clinical Practice

Background:

• Managed care organizations (MCOs) implement drug formularies to control costs.
• Physician perceptions of formulary restrictions may influence prescribing behavior.
• Understanding the gap between perceived and actual restrictions is crucial for effective healthcare management.

Purpose of the Study:

• To compare emergency medicine physicians' perceptions of managed care restrictions on antibiotic prescribing with objective data.
• To quantify the discrepancy between perceived and actual formulary impacts on antibiotic selection.

Main Methods:

• A survey assessed general perceptions of managed care restrictions among 17 emergency medicine physicians.
• Objective prescribing data was collected by reviewing recent patient cases for specific antibiotic choices.
• Statistical analysis (p-value) was used to compare perceived versus actual restriction frequencies.

Main Results:

• Physicians reported prescribing non-first-choice antibiotics due to managed care restrictions 32% of the time.
• Objective review showed actual non-first-choice antibiotic prescribing occurred only 6% of the time (p <.0001).
• A significant overestimation of formulary restrictions by physicians was identified.

Conclusions:

• Emergency medicine physicians in this managed care setting significantly overestimated the impact of formularies on their antibiotic prescribing.
• Perceived restrictions by managed care significantly differ from objective measures.
• Further research is needed to understand and address this perception bias in clinical practice.