Biomedical subjects
H F Blissenbach
Publications and source records attributed to H F Blissenbach.
Medical committee enforcement of policy limiting postsurgical antibiotic use.
A hospital policy enforced by medical staff committees limiting prophylactic antibiotic use is described. The pharmacy department is authorized to discontinue prophylactic antibiotic orders at 72 hours postoperatively for patients in whom there is no sign of infection. Decentralized pharmacists screen antibiotic orders for formulary status and appropriateness. Forty-eight hours postoperatively, pharmacists evaluate patients for infection and document in each patient's chart that the antibiotic will be discontinued within 24 hours unless renewed by the physician. Pharmacists document situations in which a physician renews the antibiotic and no infection is present. Audits of antibiotic use are performed, and the quality assurance, medical credentialing, and surgery committees deal with noncompliant physicians. For 153 prophylactic antibiotic orders audited in January 1981 before the program was implemented, approximately 50% were discontinued within 72 hours. During the same period in January 1984 when the 72-hour policy had been in effect one year, this percentage had increased to 85%. Two individual surgeons and one group of surgeons (urologists) who never complied with the policy were referred in 1983 to the surgery committee. After consultation, the two surgeons changed their standing orders to comply with the policy, and the urologists were granted an exception that was to be reviewed annually. The support of the medical staff in ensuring physician compliance has been the key element in the success of this policy.
Patient drug self-administration improves regimen compliance.
Through a hospital's three-phase program, inpatients learned about their medications and gradually accepted responsibility for self-administration of these medications, for developing their schedules, and for adhering to their regimens. A postdischare follow-up study showed that the program had substantially improved patient compliance with medication regimens.
Use of cost-consequence models in managed care.
Functioning effectively as a pharmacy benefit manager has been defined as purchasing the best product at the lowest possible cost. In the simplest terms, this means purchasing discounted drugs; in the most complex terms, it means managing drug use. However, if the entire medical picture were analyzed, use of more expensive drugs might actually lower total direct medical costs. Currently, formulary decisions are based on both therapeutic necessity and cost. The decision to administer one drug rather than another is directed by community practice patterns and the final price. The availability of information to demonstrate differences, if any, in total treatment costs between the two agents would considerably enhance therapeutic decision making and would guide treatment by an outcome-based drug formulary. The question that requires an answer is centered on the value equation: Value = outcomes/cost. Before paying more for drug A than for drug B, the payer will demand to see value. When available, direct and indirect cost information will be applied to position drugs appropriately in a drug formulary.