Developing and implementing a model for changing physicians' prescribing habits - the role of clinical pharmacy in leading the change

Background and objective: Budgetary constraints led the Israeli Hillel Yaffe Medical Center management to implement policies for reducing expenditure while maintaining the quality of care. For this purpose, the pharmacy services management developed and implemented a three-tier intervention feedback model for changing physicians' prescribing habits, and achieving cost-effective changes in antibiotic utilization. Methods: A prospective drug utilization evaluation was conducted to profile antibiotic utilization. The results established a base from which a three-tier feedback, evidence-based intervention model was built. This model corresponds to the following three hierarchical levels: Level 1 activities involved management actions that influenced all levels of staff and concentrated mainly on the creation of guidelines. Level 2 activities involved the reorganization of the restricted antibiotics prescription authorization system, through the co-operation of the clinical pharmacy unit and the hospital infection control specialist. Level 3 focussed on clinical pharmacist activities on the wards. The model was implemented and assessed in the hospital from June 2002 until December 2004. Results and discussion: Implementation of the model resulted in a cumulative decrease of 6473 i.v. antibiotics daily defined doses (DDDs) and a parallel increase in total oral antibiotic DDDs (Table 1). These changes were especially notable with high-bioavailability antibiotics and co-amoxiclav, where over 2.5 years there was a reduction of 2472 and 4752 i.v. DDDs, respectively (P < 0.000). The successful implementation of the model resulted in a reduction of 375 000 NIS (similar to 66 190 \euro) in pharmacy antibiotic costs, equivalent to 10 i.v. DDDs or 570 NIS (similar to 102 \euro) saved per clinical pharmacist working day. Conclusions: Our study demonstrates the successful implementation of a three-tier model for changing physicians' antibiotic prescribing.