Economics of using pharmacists as advisers to physicians in risk-sharing contracts

Training Physicians to Provide High-Value, Cost-Conscious Care

“…† This feedback could focus on various elements, which, in turn, influenced how trainees learned from feedback. Feedback could focus on volume (such as numbers of requested tests), 43,48,55,[75][76][77] costs (eg, total costs of antibiotic prescriptions), 14,21,22,28 or appropriateness (eg, extent of adherence to guidelines). 67 Feedback could center on physicians' individual utilization or their utilization in relation to that of others.…”

“…67 Feedback could center on physicians' individual utilization or their utilization in relation to that of others. 34,49,52,67,76 Another element of importance was the frequency of feedback. 21,40,67 One high-quality study sent emails to 15 physicians in the upper 50th percentile for expenditures to point out the differences in their spending behavior compared with their peers over a 3-month period.…”

“…Peer-or supervisor-facilitated reflection on medical decisions and their influence on the quality and cost-effectiveness of care was the focus of several studies. ‡ Supervisors, 39,55,72 peers, 69,79 and experts 27,37,53,56,64,66,76 in several clinical settings were the initiators of reflective discussions. 22,25,34,39 For example, they asked reflective questions during morning rounds or grand rounds and in the presence of other health care professionals.…”

“…Furthermore, 59 of these residents claimed that better knowledge of costs would influence their ordering behavior. The use of incentives (financial or otherwise) to modify practice 28,47,55,76,84,86 and payment systems{are also examples of how macrolevel decisions could influence individual physicians. The influence of the reimbursement system on the success of costcontainment interventions was identified by Lyle et al 86 In this high-quality study, it was noted that the structure for financing hospital care could run counter to hospital economics, since a decrease in utilization is related to a decline in third-party payments.…”

The Pharmacist's Duty to Warn

“…These programs increased physician-pharmacist interactions thereby significantly decreasing the costs of patient treatment. 81 Therefore, it should be clear that physicians and pharmacists work well collaboratively with the objective of better patient clinical outcomes, and that imposing a duty to inform on pharmacists will not negatively impact this relationship.…”