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Quality improvement project: USA

An example of outstanding improvements

Quality improvement project: USA

A clinic flow protocol was developed where the providers consciously started prescribing generic medications for the brand names when available.



Improving viable low-cost generic medication prescription rate in primary care pediatric practice

BMJ published the internal quality measures report that saved the pediatric clinics of the Michigan State University College of Human Medicine (MSU-CHM)  USD$100000 (GBP £70,000) over a two year period.


The cost of prescription drugs as a part of total healthcare spending has been growing significantly across the world. The per capita national health expenditure in the United States in 2013 was $9250, and the total national health expenditure was $2.9 trillion.

Prescription costs in the United States account for 9.3% of total expenditure, which is about $290bn to $300bn. The cost saving for countries that prescribe generics is very significant, and estimated to be about 60% to 65% over brand name medications.


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An internal review of the Michigan State University (MSU) health team revealed that the College of Human Medicine (CHM) pediatric clinics lagged behind severely in prescribing generic medications, compared to their peers of other primary care large group practices, including family medicine, family practice, internal medicine, and specialty practices such as women’s health. 

 

The overall average generic medication prescribing rate was 34% to 35% for the health team, whereas the rate was 21% for the CHM pediatric clinics.

The clinic obtained its baseline measurement  by collecting data on the top 10 brand name medications prescribed across all providers in both clinics.  It also identified responsible internal stakeholders, which included nurses who refilled medications, care managers, and the health information technology (HIT) team who were responsible for labeling medications.

Based on that data a plan was formulated to target medications for ADHD, asthma, and allergies. HIT was requested to add the generic names for all the stimulants in a way that was easily searchable and recognisable. The names had a tag after them that indicated they were generic to a specific brand name. A clinic flow protocol was developed where the providers consciously started prescribing generic medications for the brand names when available and since, the nursing staff has been requested to change all brand names into generic medications during refill. Patients’ families were also informed of the change and assured that these changes would be monitored and that all the generic medications were approved, low cost, and had comparable therapeutic efficacy.

After implementing the project over eight quarters, the overall rate of prescribing generic medications for all clinical visits improved from an average of 21% from the prior years to 53% at the end of 12 months and 65.5% at the end of two years. The estimated cost implications calculated just for top three brand name drugs switched to generics are approximately $53800 USD for four quarters and $100000 across the two year age of the project.

Improving viable low-cost generic medication prescription rate in primary care pediatric practice


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