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Cost-Benefit Issues in the Practice of Internal Medicine

Cost-Benefit Issues in the Practice of Internal Medicine Abstract The rapidly escalating costs of medical treatment would suggest that everything be done to limit expenses when it can be done without jeopardizing patient care. Unfortunately, cost consciousness is a relatively new concept for most physicians and even today is not emphasized in most medical education programs. Over the past five years numerous articles have been published indicating ways in which specific cost-effective measures can be taken that can positively influence the cost of routine medical care. This article details a number of well-documented steps practicing physicans might consider to decrease the cost of medical treatment without compromising patient care. (Arch Intern Med. 1991;151:1165-1168) References 1. Counsel report: health care in transition . JAMA. 1986;256:3384-3390.Crossref 2. Byyny RL. Challenges in the education of the general internist . Arch Intern Med. 1988;148:369-372.Crossref 3. Epstein AM, Stern RS, Tognetti J, et al. The association of patients' socioeconomic characteristics with the length of stay and hospital charge within diagnostic-related groups . N Engl J Med. 1988;318:1579-1585.Crossref 4. Munoz E, Rosner F, Chalfin D, Goldstein J, Margolis IB, Wise L. Financial risk and hospital cost for elderly patients . Arch Intern Med. 1988;148:909-912.Crossref 5. Povar G, Moreno J. Hippocrates and the health maintenance organization . Ann Intern Med. 1988;109:419-424.Crossref 6. Moore SH. An HMO with private family physicians coordinating care and controlling costs . J Fam Pract. 1981;13:508-512. 7. Jencks SF, Kay T. Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges? JAMA. 1987;257:198-202.Crossref 8. Bloom BS, Wierz DJ, Pauly MV. Cost and price of comparable branded and generic pharmaceuticals . JAMA. 1986;256:2523-2530.Crossref 9. Chren MM, Landefeld CS, Murray TH. Doctors, drug companies, and gifts . JAMA. 1989;262:3448-3451.Crossref 10. Graves J. Frequent-flyer programs for drug prescribing . N Engl J Med. 1987;317:252. 11. Goldfinger SE. A matter of influence . N Engl J Med. 1987;316:1408-1409.Crossref 12. Smith R. Doctor and the drug industry: too close for comfort . Br Med J. 1986;293:905-906.Crossref 13. Bricker EM. Industrial marketing and medical ethics . N Engl J Med. 1989;320:1690-1692.Crossref 14. Sanford JP. Guide to Antimicrobial Therapy 1989 . Bethesda, Md: Antimicrobial Therapy Inc; 1989. 15. Wilkowske CJ, Hermans PE. General principles of antimicrobial therapy . Mayo Clin Proc. 1987;62:789-798.Crossref 16. Ciprofloxacin . Med Lett. 1988;30:11-14. 17. Wolfson JS, Hooper DC. Norfloxacin: a new targeted fluoroquinolone antimicrobial agent . Ann Intern Med. 1988;108:238-251.Crossref 18. Walker RC, Wright AJ. The quinolones . Mayo Clin Proc. 1987;62:1007-1012.Crossref 19. Neu JC. New antibiotics: areas of appropriate use . J Infect Dis. 1987;155:403-417.Crossref 20. The Urinary Tract Infection Study Group. Coordinated multicenter study of norfloxacin vs trimethoprim-sulfamethoxazole treatment of symptomatic urinary tract infections . J Infect Dis. 1987;155:170-177.Crossref 21. Rubin M, Pizzo PA. Update on the management of the febrile neutropenic patient . Res Staff Phys. 1989;35:25-44. 22. Pizzo PA, Hathorn JW, Hiemez J, et al. A randomized trial comparing combination antibiotic therapy to monotherapy in cancer patients with fever and neutropenia . N Engl J Med. 1986;315:552.Crossref 23. Wade JC, Standiford HC, Drusano D, et al. Potential of imipenem as single-agent empiric antibiotic therapy of febrile neutropenic patients with cancer . Am J Med. 1985;78( (suppl 5A) ):62-72.Crossref 24. Rubin M, Hathorn JW, Pizzo PA. Controversies in the management of febrile neutropenic cancer patients . Cancer Invest. 1988;6:167.Crossref 25. Russo TA, Cook S, Borbach SL. Intramuscular ceftriaxone in home parenteral therapy . Antimicrob Agents Chemother. 1988;32:1439-1440.Crossref 26. Hermans PE, Wilhelm MP. Vancomycin. Mayo Clin Proc. 1987;62:901-905.Crossref 27. Dudley MN, McLaughlin JC, Carrington G, Frick J, Nightingale CH, Quintiliani R. Oral bacitracin vs vancomycin therapy for Clostridium difficile-induced diarrhea: a randomized double-blind trial . Arch Intern Med. 1986;146:1101-1109.Crossref 28. Teasley DG, Gerding DN, Olson MM, et al. Prospective randomized trial of metronidazole vs vancomycin for Clostridium difficile-associated diarrhea and colitis . Lancet. 1983;2:1043-1046.Crossref 29. Rosenblatt JE, Edson RS. Metronidazole . Mayo Clin Proc. 1987;62:1013-1017.Crossref 30. Cressman MD, Gifford RW Jr. Pharmacologic management of hypertension . Postgrad Med. 1989;85:259-268. 31. The 1988 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure . Arch Intern Med. 1988;148:1023-1038.Crossref 32. Wikstrand J, Westergren G, Berglund G, et al. Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years: report from a double-blind international multicenter study . JAMA. 1986;255:1304-1310.Crossref 33. Cubeddu LX, Arama J, Singh B, et al. A comparison of verapamil and propranolol for the initial treatment of hypertension: racial differences in response . JAMA. 1986;256:2214-2221.Crossref 34. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension . Lancet. 1981;2:539-543. 35. Hulley SB, Furberg CD, Forland B, et al. Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone . Am J Cardiol. 1985;56:913-920.Crossref 36. Pollare T, Lithell H, Berne C. A comparison of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension . N Engl J Med. 1989;321:868-873.Crossref 37. LaCroix AZ, Wienpahl J, White LR, et al. Thiazide diuretic agents and the incidence of hip fracture . N Engl J Med. 1990;332:286-290.Crossref 38. Khan AH. Beta-adrenoreceptor blocking agents: their role in reducing chances of recurrent infarction and death . Arch Intern Med. 1983;143:1759-1762.Crossref 39. Psaty BM, Koepsell TD, Logerfo JP, Wagner EH, Invi TS. Betablockers and primary prevention of coronary heart disease in patients with high blood pressure . JAMA. 1989;261:2087-2094.Crossref 40. Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfeldt D, Berglund G. Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY Study . JAMA. 1988;259:1976-1983.Crossref 41. Maling TJ, Kawach I. Minimum effective dosage in drug treatment of hypertension: a cost effective strategy for prescribers . N Z Med J. 1990;103:231-233. 42. Williams GH. Converting-enzyme inhibitors in the treatment of hypertension . N Engl J Med. 1988;319:1517-1526.Crossref 43. Prince MJ, Stuart CA, Padia M, et al. Metabolic effects of hydrochlorothiazide and enalapril during treatment of the hypertensive diabetic patient: enalapril for hypertensive diabetics . Arch Intern Med. 1988;148:2363-2368.Crossref 44. American Medical Association Department of Drugs, Division of Drugs and Technology. Drug Evaluations . 6th ed. Chicago, Ill: American Medical Association; 1986. 45. Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ III. Psychotropic drug use and the risk of hip fracture . N Engl J Med. 1987;316:363-369.Crossref 46. Rashiq S, Logan RFA. Role of drugs in fractures of the femoral neck . BMJ. 1986;292:861-863.Crossref 47. Hayes PE, Kristoff CA. Adverse reactions to five new antidepressants . Clin Pharm. 1986;5:471-480. 48. Mazanec DJ. Nonsteroidal anti-inflammatory drug therapy: clinical use in a high risk group-the elderly . Cleve Clin J Med. 1988;55:419-425.Crossref 49. Baum C, Kennedy DL, Forbes MB. Utilization of nonsteroidal antiinflammatory drugs . Arthritis Rheum. 1985;28:686-692.Crossref 50. Huskisson EC. How to choose a non-steroidal anti-inflammatory drug . Clin Rheum Dis. 1984;10:313-323. 51. Scott DL, Roden S, Marshall T, Kendall MJ. Variations in responses to nonsteroidal anti-inflammatory drugs . Br J Clin Pharmacol. 1982;14:691-694.Crossref 52. Carson JL, Strom BL, Morse L, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 53. Lien TA, Fleisher GR, Schwartz JS. Cost-effectiveness of rapid latex agglutination testing and throat culture for streptococcal pharyngitis . Pediatrics. 1990;85:246-256. 54. Komaroff AL, Pass TM, Aronson MD, et al. The prediction of streptococcal pharyngitis in adults . J Gen Intern Med. 1986;1:1-7.Crossref 55. Mitchell N, Stapleton FB. Routine admission urinalysis examination in pediatric patients: a poor value . Pediatrics. 1990;86:345-349. 56. Davis FB, Estruch MT, Samson-Corvera EB, et al. Management of anticoagulation in outpatients . Arch Intern Med. 1977;137:197-202.Crossref 57. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med. 1988;148:36-80.Crossref 58. Schectman JM, Paulson LG. The cost-effectiveness of three thyroid function testing strategies for suspicion of hypothyroidism in a primary care setting . J Gen Intern Med. 1990;5:9-15.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cost-Benefit Issues in the Practice of Internal Medicine

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400060093016
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Abstract

Abstract The rapidly escalating costs of medical treatment would suggest that everything be done to limit expenses when it can be done without jeopardizing patient care. Unfortunately, cost consciousness is a relatively new concept for most physicians and even today is not emphasized in most medical education programs. Over the past five years numerous articles have been published indicating ways in which specific cost-effective measures can be taken that can positively influence the cost of routine medical care. This article details a number of well-documented steps practicing physicans might consider to decrease the cost of medical treatment without compromising patient care. (Arch Intern Med. 1991;151:1165-1168) References 1. Counsel report: health care in transition . JAMA. 1986;256:3384-3390.Crossref 2. Byyny RL. Challenges in the education of the general internist . Arch Intern Med. 1988;148:369-372.Crossref 3. Epstein AM, Stern RS, Tognetti J, et al. The association of patients' socioeconomic characteristics with the length of stay and hospital charge within diagnostic-related groups . N Engl J Med. 1988;318:1579-1585.Crossref 4. Munoz E, Rosner F, Chalfin D, Goldstein J, Margolis IB, Wise L. Financial risk and hospital cost for elderly patients . Arch Intern Med. 1988;148:909-912.Crossref 5. Povar G, Moreno J. Hippocrates and the health maintenance organization . Ann Intern Med. 1988;109:419-424.Crossref 6. Moore SH. An HMO with private family physicians coordinating care and controlling costs . J Fam Pract. 1981;13:508-512. 7. Jencks SF, Kay T. Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges? JAMA. 1987;257:198-202.Crossref 8. Bloom BS, Wierz DJ, Pauly MV. Cost and price of comparable branded and generic pharmaceuticals . JAMA. 1986;256:2523-2530.Crossref 9. Chren MM, Landefeld CS, Murray TH. Doctors, drug companies, and gifts . JAMA. 1989;262:3448-3451.Crossref 10. Graves J. Frequent-flyer programs for drug prescribing . N Engl J Med. 1987;317:252. 11. Goldfinger SE. A matter of influence . N Engl J Med. 1987;316:1408-1409.Crossref 12. Smith R. Doctor and the drug industry: too close for comfort . Br Med J. 1986;293:905-906.Crossref 13. Bricker EM. Industrial marketing and medical ethics . N Engl J Med. 1989;320:1690-1692.Crossref 14. Sanford JP. Guide to Antimicrobial Therapy 1989 . Bethesda, Md: Antimicrobial Therapy Inc; 1989. 15. Wilkowske CJ, Hermans PE. General principles of antimicrobial therapy . Mayo Clin Proc. 1987;62:789-798.Crossref 16. Ciprofloxacin . Med Lett. 1988;30:11-14. 17. Wolfson JS, Hooper DC. Norfloxacin: a new targeted fluoroquinolone antimicrobial agent . Ann Intern Med. 1988;108:238-251.Crossref 18. Walker RC, Wright AJ. The quinolones . Mayo Clin Proc. 1987;62:1007-1012.Crossref 19. Neu JC. New antibiotics: areas of appropriate use . J Infect Dis. 1987;155:403-417.Crossref 20. The Urinary Tract Infection Study Group. Coordinated multicenter study of norfloxacin vs trimethoprim-sulfamethoxazole treatment of symptomatic urinary tract infections . J Infect Dis. 1987;155:170-177.Crossref 21. Rubin M, Pizzo PA. Update on the management of the febrile neutropenic patient . Res Staff Phys. 1989;35:25-44. 22. Pizzo PA, Hathorn JW, Hiemez J, et al. A randomized trial comparing combination antibiotic therapy to monotherapy in cancer patients with fever and neutropenia . N Engl J Med. 1986;315:552.Crossref 23. Wade JC, Standiford HC, Drusano D, et al. Potential of imipenem as single-agent empiric antibiotic therapy of febrile neutropenic patients with cancer . Am J Med. 1985;78( (suppl 5A) ):62-72.Crossref 24. Rubin M, Hathorn JW, Pizzo PA. Controversies in the management of febrile neutropenic cancer patients . Cancer Invest. 1988;6:167.Crossref 25. Russo TA, Cook S, Borbach SL. Intramuscular ceftriaxone in home parenteral therapy . Antimicrob Agents Chemother. 1988;32:1439-1440.Crossref 26. Hermans PE, Wilhelm MP. Vancomycin. Mayo Clin Proc. 1987;62:901-905.Crossref 27. Dudley MN, McLaughlin JC, Carrington G, Frick J, Nightingale CH, Quintiliani R. Oral bacitracin vs vancomycin therapy for Clostridium difficile-induced diarrhea: a randomized double-blind trial . Arch Intern Med. 1986;146:1101-1109.Crossref 28. Teasley DG, Gerding DN, Olson MM, et al. Prospective randomized trial of metronidazole vs vancomycin for Clostridium difficile-associated diarrhea and colitis . Lancet. 1983;2:1043-1046.Crossref 29. Rosenblatt JE, Edson RS. Metronidazole . Mayo Clin Proc. 1987;62:1013-1017.Crossref 30. Cressman MD, Gifford RW Jr. Pharmacologic management of hypertension . Postgrad Med. 1989;85:259-268. 31. The 1988 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure . Arch Intern Med. 1988;148:1023-1038.Crossref 32. Wikstrand J, Westergren G, Berglund G, et al. Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years: report from a double-blind international multicenter study . JAMA. 1986;255:1304-1310.Crossref 33. Cubeddu LX, Arama J, Singh B, et al. A comparison of verapamil and propranolol for the initial treatment of hypertension: racial differences in response . JAMA. 1986;256:2214-2221.Crossref 34. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension . Lancet. 1981;2:539-543. 35. Hulley SB, Furberg CD, Forland B, et al. Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone . Am J Cardiol. 1985;56:913-920.Crossref 36. Pollare T, Lithell H, Berne C. A comparison of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension . N Engl J Med. 1989;321:868-873.Crossref 37. LaCroix AZ, Wienpahl J, White LR, et al. Thiazide diuretic agents and the incidence of hip fracture . N Engl J Med. 1990;332:286-290.Crossref 38. Khan AH. Beta-adrenoreceptor blocking agents: their role in reducing chances of recurrent infarction and death . Arch Intern Med. 1983;143:1759-1762.Crossref 39. Psaty BM, Koepsell TD, Logerfo JP, Wagner EH, Invi TS. Betablockers and primary prevention of coronary heart disease in patients with high blood pressure . JAMA. 1989;261:2087-2094.Crossref 40. Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfeldt D, Berglund G. Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY Study . JAMA. 1988;259:1976-1983.Crossref 41. Maling TJ, Kawach I. Minimum effective dosage in drug treatment of hypertension: a cost effective strategy for prescribers . N Z Med J. 1990;103:231-233. 42. Williams GH. Converting-enzyme inhibitors in the treatment of hypertension . N Engl J Med. 1988;319:1517-1526.Crossref 43. Prince MJ, Stuart CA, Padia M, et al. Metabolic effects of hydrochlorothiazide and enalapril during treatment of the hypertensive diabetic patient: enalapril for hypertensive diabetics . Arch Intern Med. 1988;148:2363-2368.Crossref 44. American Medical Association Department of Drugs, Division of Drugs and Technology. Drug Evaluations . 6th ed. Chicago, Ill: American Medical Association; 1986. 45. Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ III. Psychotropic drug use and the risk of hip fracture . N Engl J Med. 1987;316:363-369.Crossref 46. Rashiq S, Logan RFA. Role of drugs in fractures of the femoral neck . BMJ. 1986;292:861-863.Crossref 47. Hayes PE, Kristoff CA. Adverse reactions to five new antidepressants . Clin Pharm. 1986;5:471-480. 48. Mazanec DJ. Nonsteroidal anti-inflammatory drug therapy: clinical use in a high risk group-the elderly . Cleve Clin J Med. 1988;55:419-425.Crossref 49. Baum C, Kennedy DL, Forbes MB. Utilization of nonsteroidal antiinflammatory drugs . Arthritis Rheum. 1985;28:686-692.Crossref 50. Huskisson EC. How to choose a non-steroidal anti-inflammatory drug . Clin Rheum Dis. 1984;10:313-323. 51. Scott DL, Roden S, Marshall T, Kendall MJ. Variations in responses to nonsteroidal anti-inflammatory drugs . Br J Clin Pharmacol. 1982;14:691-694.Crossref 52. Carson JL, Strom BL, Morse L, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 53. Lien TA, Fleisher GR, Schwartz JS. Cost-effectiveness of rapid latex agglutination testing and throat culture for streptococcal pharyngitis . Pediatrics. 1990;85:246-256. 54. Komaroff AL, Pass TM, Aronson MD, et al. The prediction of streptococcal pharyngitis in adults . J Gen Intern Med. 1986;1:1-7.Crossref 55. Mitchell N, Stapleton FB. Routine admission urinalysis examination in pediatric patients: a poor value . Pediatrics. 1990;86:345-349. 56. Davis FB, Estruch MT, Samson-Corvera EB, et al. Management of anticoagulation in outpatients . Arch Intern Med. 1977;137:197-202.Crossref 57. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med. 1988;148:36-80.Crossref 58. Schectman JM, Paulson LG. The cost-effectiveness of three thyroid function testing strategies for suspicion of hypothyroidism in a primary care setting . J Gen Intern Med. 1990;5:9-15.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1991

References