Health Care Costs and Financing

Educational outreach to individual physicians to improve antihypertensive drug prescribing can reduce drug costs

Low-dose thiazide diuretics are recommended as the initial medication for patients with hypertension (unless they have contraindications to the drugs). Educational outreach to individual physicians (individual academic detailing) to improve recommended prescribing of antihypertensive medications can reduce drug costs. Academic detailing involves the use of trained "detailers"—usually doctors or clinical pharmacists—who conduct face-to-face visits with prescribers to encourage use of guideline-recommended medications. However, due to the perception of the costs of this face-to-face intervention, academic detailing has not been widely adopted.

Researchers at the HMO Research Network Center for Education and Research in Therapeutics randomized three HMO practice sites to individual academic detailing (a single clinical visit from a trained physician, at a cost of $7,200), three sites to group academic detailing (detailers delivered 45-minute academic detailing sessions to seven or eight clinicians, at a cost of $5,500), and three sites to usual care (receiving antihypertensive prescribing guidelines only, at a cost of $1,000).

The group detailing intervention resulted in no change in the average daily cost of antihypertensive agents. However, only 55 percent of eligible physicians participated in the educational sessions. Estimated annual cost savings (after the cost of the program) for the three centers randomized to individual detailing was $21,711 or $289 in savings per physician. Extrapolating these results to the plan level (7,600 newly diagnosed and treated hypertensive patients in a typical year) would result in an estimated $155,000 savings in the cost of antihypertensive medications with universal adoption of the individual detailing intervention.

The study was supported in part by the Agency for Healthcare Research and Quality (HS12019 and HS10391).

More details are in "Economic analysis of a randomized trial of academic detailing interventions to improve use of antihypertensive medications," by Steven R. Simon, M.D., M.P.H., Hector P. Rodriguez, M.P.H, Ph.D., Sumit R. Majumdar, M.D., M.P.H., and others, in the January 2007 Journal of Clinical Hypertension 9(1), pp. 15-20.

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