Drug Shortage: Unexpected Reward
Serendipity and medicine is a wonderful thing.
Serendipity and medicine is a wonderful thing. It was serendipity that allowed Fleming to discover penicillin in the 1940s, and serendipity that led Von Merring and Miinkowski to determine that diabetes was a disease of the pancreas.
Serendipity and pharmacy practice is the topic of an article published in BMG Quality & Safety. Written by a team of pharmacists from the University of Texas Southwestern Medical Center in Dallas, Texas, it describes how a drug shortage led to the adoption of a high-value care practice.
According to the authors, prescribers often view change introduced to save money as suspicious regardless of whether they are evidence-based and will have no adverse effect on quality of care. These pharmacists had faced resistance to limiting the number of proton pump inhibitors (PPIs), and particularly, use of oral drugs as opposed to intravenous drugs under appropriate circumstances.
It was a shortage of a specific intravenous PPI and a price increase of 344% that stimulated change. This dilemma prompted the pharmacists to perform retrospective review for all intravenous PPIs in the year preceding the shortage. They found that the average cost per month for intravenous PPIs approach $12,000, and most of the orders came from wards (as opposed to intensive care units, postoperative care units, or the emergency department).
Clearly, any change they could implement would be "high-value."
Due to a pressing need to address intravenous PPIs, they implemented (and prescribers rapidly adopted) interventions that led to a 76% decrease in intravenous PPI use. After the drug shortage resolved, they continued the identical interventions, and sustained the decrease. They estimate that the cumulative savings are roughly $200,000.
More importantly, prescribing practices changed. Prescribers were more likely to use prebuilt order sets and pharmacists were less likely to have to intervene.
The authors also discussed concerns of purchasing drugs that are in shortage status from secondary sources. They concluded that colleagues need to work diligently to lower health care costs without sacrificing quality to increase value.
Gupta A, Rahman A, Alvarez KS, et al. Drug shortage leading to serendipitous adoption of high-value care practice. BMJ Qual Saf. 2017 Aug 1. pii: bmjqs-2017-007015. doi: 10.1136/bmjqs-2017-007015. [Epub ahead of print]