The influence of drug use in university hospitals on the pharmaceutical consumption in their surrounding communities

Abstract

Aim To investigate the influence of hospital drug choices on pharmaceutical consumption for nine competitive classes in the surrounding community. Methods Ecological study. Data from the national survey on drugs in hospitals were used to extract quantities purchased by 25 French university hospitals for three ‘hospital classes’ (EPOs, LMWHs and setrons) and six ‘ambulatory classes’ (PPIs, ACEIs and ARBs, statins, α‐adrenoreceptor antagonists (AAAs) and selective serotonin re‐uptake inhibitors SSRIs). Re‐imbursed quantities for patients living in the hospital's catchment area were extracted from the national health insurance database. The relationship between the use of a brand in hospitals and their catchment areas was assessed using multivariate linear regressions with instrumental variables. Results An increase of 1 day of treatment with one brand in the hospital was associated with a significant increase of 2.8 days of treatment with the same brand in the catchment area. However, results strongly varied according to classes. An increase of 1 day of treatment in the hospital was significantly associated with an increase of 0.21 day for ‘hospital classes’ and 21.8 days for ‘ambulatory classes’ in the catchment area. Strong variations were seen across ‘ambulatory classes’. The effect was maximal for cardiovascular classes and not significant for AAAs and SSRIs. The size of the effect also varied with hospital characteristics: small and proximity university hospitals exerted the greatest influence. Conclusions Hospital consumption influences the use of drugs in the community. A significant effect was found, especially for competitive classes used on a long‐term basis. The economic consequences of these findings need to be addressed.

Hospitals and the generic versus brand‐name prescription decision in the outpatient sector

“…The pharmaceutical representative was the reason most cited, followed by hospital consultants and the observation of hospital prescribing. Similarly, Gallini, Legal, and Taboulet (2013) find that university hospitals have a significant influence on the pharmaceutical consumption in surrounding communities.…”

“…This strategy is rational from the companies' perspective if the decrease in profits through rebates and discounts in kind can be expected to be overcompensated by an increase in profits generated in the outpatient sector (Ford, 2012;Gallini et al, 2013). They have stepped up their marketing activities in hospitals through rebates and the free-of-charge dissemination of (brand name) drugs in an attempt to promote subsequent prescriptions by outpatient care physicians.…”

Barriers to access and use of high cost medicines: A review

“…An ecological study assessed the treatment duration for originator brand medicines including HCMs in hospitals and its catchment areas. Varying by the type of hospital and kind of medicines, a longer duration of use in hospitals leads to a longer use in the adjacent community [62]. One reason is the varying medicine compliance of patients between inpatient and outpatient settings.…”

The Determination of the Factors Affecting Pharmaceutical Consumption in Respect to Provinces in Turkey

“…Evaluations on the consumption of various antibiotic medicines across the world have been done in the recent study (Van Boeckel et al, 2014). Gallini et al (2012) have examined the effect of medicine preferences of hospitals on pharmaceutical consumption. It has been determined that the consumption in hospitals has not positively affected the pharmaceutical consumption.…”