PRACTICE GUIDELINES - DEVELOPING GUIDELINES FOR LOCAL USE - ALGORITHMS FOR COST-EFFICIENT OUTPATIENT MANAGEMENT OF CARDIOVASCULAR DISORDERS IN A VA MEDICAL-CENTER

Background: Increasing medication costs have a major impact on health care delivery systems with fixed budgets. Drugs used in the outpatient treatment of hypertension, angina, and congestive heart failure account for over 30% of the pharmacy costs at the Cleveland Veterans Affairs Medical Center. Purpose: The authors describe the development of algorithms for the cost-efficient management of these common problems with particular attention to the use of calcium channel blockers and angiotensin-converting enzyme inhibitors; present the rationale of the algorithms; discuss lessons learned from the development and initial implementation of the algorithms; and present plans for evaluating implementation of the algorithms and their effect on cost and quality of care.