Efficacy and cost-containment in hospital pharmacotherapy: state of the art and future directions.

in determining the safety, efficacy, and efficiency of drug utilization, relatively few studies have investigated approaches designed to improve the ways physicians make drug-use decisions. Quality assurance approaches, including those of the Joint Commission on Hospital Accreditation, often emphasize audit and identification of problems, but are less oriented toward the establishment of effective mechanisms to change the problems thus identified (Anderson and Shields 1982). Traditional continuing education programs, relying on voluntary participation of physicians, have generally failed to reach those physicians most in need of training (Lewis and Hassanein 1970). The pharmaceutical industry has taken a central role in continuing drug education for the practicing physician, but there is concern that the commercial origins of such efforts may have a biasing effect on the information thus provided (Avorn, Chen, and Hartley 1982). Medication use in hospitals accounts for a large proportion of the $25 billion spent annually on drugs in the United States (Freeland and Schendler 1983), and represents an important percentage of hospital expenditures.