Influencing prescribing behavior by adapting computerized order-entry pathways

A program is described in which informational text was inserted into a computerized drug order-entry pathway to alter prescribing patterns and contain costs. In April 1986 the pharmacy and therapeutics committee at a 700-bed teaching hospital recommended that cefonicid be used instead of cefuroxime to treat adult patients with community-acquired pneumonia in which infection with Haemophilus influenzae or gram-negative enteric rods was suspected; substantial cost savings were projected. A paragraph recommending cefonicid was inserted into the cefuroxime order-entry screen in November 1986. In February 1987 the screen was further modified to allow the physician to select the cefonicid alternative without returning to the drug index. A final change was made in November 1987 to allow the physician to select ampicillin or erythromycin directly from the cefuroxime screen as well. The cost and relative use of cefonicid and cefuroxime were examined in specific patients with pneumonia--those assigned to diagnosis-related group 89--for whom either drug was prescribed. From January 1986 to December 1987, the percentage of these patients who were prescribed cefuroxime decreased from 100% to 22%, while the percentage of patients receiving cefonicid increased from 0% to 78%. The average acquisition cost of the two antibiotics per patient decreased from $123 to $48. Although other variables may have affected prescribing patterns and this method of drug therapy intervention has some disadvantages, such as the need for physician cooperation, the concept warrants further attention. Adaptation of computerized order-entry pathways may increase the ability of pharmacy to influence prescribing behavior and control costs.