PHYSICIANS KNOWLEDGE OF DRUG COSTS FOR THE ELDERLY

OBJECTIVE: To measure physicians' knowledge of the costs of commonly used medications in geriatric practice and how such awareness influences their prescribing decisions. DESIGN: A survey of pharmacies to determine the prices of 14 commonly used brand name and generic drugs and an in-person survey of physicians asking them to price these drugs. SETTING: Eastern Massachusetts PARTICIPANTS: One hundred thirty-two primary care practitioners were surveyed during hospital rounds and medical society meetings. MEASUREMENT: The study examined physician awareness of patients' ability to afford drugs, the use of generic drugs, clinical decision-making practices, and the physicians' level of knowledge of drug costs. Actual drug prices were measured by surveying 22 pharmacies. RESULTS: Of the 132 respondents, 85% reported that inability to afford medications was a problem for some of their patients. One in five indicated that they did not believe generic drugs to be as safe or effective as brand name drugs, and 30% reported that they rarely or never had access to information about drug costs. Of the 99 physicians who estimated drug prices, there was a marked trend toward underestimation of the prices of more expensive drugs as well as overestimation of the prices of less costly drugs. Physician estimates of prices were highly variable; their estimates were much more variable than pharmacy prices. Younger physicians were more likely than older physicians to make correct estimates, and specialists in internal medicine were less likely to make correct estimates than physicians in other specialties. CONCLUSIONS: These data indicate that substantial knowledge deficits exist in physicians' understanding of the economic implications of the prescriptions they write. Considerable educational activity will be necessary in this area if clinicians are to function as cost-effective prescribers under health care reform.