Prescription for prescribers: Accountability

Instead of focusing on the attainment of normal-range numbers as the rationale behind prescribing medications, three physicians argued in the New England Journal of Medicine that providers should utilize medical evidence and encourage the use of safe, effective and low-cost drugs.

“Unfortunately, clinicians frequently prescribe medications that improve numbers without necessarily improving health,” wrote the authors, led by Nancy E. Morden, MD, MPH, of the Dartmouth Hitchcock Medical Center in Lebanon, N.H. Their commentary was published July 24.

As an example, they cited one widely used drug class, thiazolidinediones, which accounted for $4.3 billion in prescriptions. More than half a million of them were for rosiglitazone, a drug restricted in the U.S. and banned in Europe due to concerns over safety.

The authors argued that clinicians should be held accountable for their prescription drug choices and listed some quality measures that could meet that goal. The levels of accountability varied.

One such measure rewards clinicians for first trying lifestyle modifications in patients with newly diagnosed hypertension. If patients are unable to lower their blood pressure using this more conservative approach, then the authors suggested designating drug classes as first-line, second-line or third-line treatments based on evidence-based guidelines.

Other measures include prescribing statins in coronary artery disease, avoiding medications when they offer no benefits or are potentially harmful and prescribing statins for coronary artery disease or beta blockers after a heart attack.

Insurance companies can play a role in holding providers accountable for responsible prescribing by revising reimbursement policies, monitoring quality and implementing performance measures based on drug claims.

As healthcare reform moves forward, so should the push toward accountable prescribing, the authors argued.

“Refining measures to incorporate best evidence and the notion of accountable prescribing could promote use of the safest and most effective drugs, better align measures with our professional responsibilities, and maximize the chance that meeting goal-driven performance measures will translate into improved population health,” they wrote.