Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

Alexandra Prados-Torres,Sebastià March-Llull,Amaia Calderón-Larrañaga,Antoni Sicras-Mainar,Bárbara Oliván-Blázquez

doi:10.1186/1472-6963-9-209

Alexandra Prados-Torres, Sebastià March-Llull + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-9-209

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Abstract

BackgroundStrategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs) regarding current cost control measures as well as their proposals for improving the effectiveness of these measures.MethodsA qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader.ResultsGPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures.ConclusionFuture investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns about injustice and feelings of impotence on the part of the GPs, which can lead to lack of interest in and disaffection with the current measures.

Highlights

Strategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals
The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns about injustice and feelings of impotence on the part of the general practitioners (GPs), which can lead to lack of interest in and disaffection with the current measures
The results were supervised by different researchers from the team, taking into account the context of interpretation by the team leader. The results of this qualitative study are presented as a function of the two thematic blocks mentioned earlier: perceptions of GPs regarding current drug cost control mechanisms and their proposals aimed at improving the effectiveness of these measures

Summary

Introduction

Strategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals. In Spain, as an example of a National Health System offering universal health coverage, prescription drug costs rose to almost 10 million euros in 2008, which represents a 6.2% increase from the costs in 2007 [2]. This increase is associated with an increase in the prevalence of chronic illnesses [3,4] and with the manufacture of and demand for new and more efficacious drugs, which are more expensive [5,6]. The literature indicates that there are ways to improve the efficiency of drug prescriptions in PC without damaging either the patient or the quality of the prescriptions [11] and this was corroborated by most doctors in a qualitative study carried out within the UK National Health Service [12]

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