The influence of drug use in university hospitals on the pharmaceutical consumption in their surrounding communities
Article first published online: 15 MAR 2013
© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 75, Issue 4, pages 1142–1148, April 2013
How to Cite
Gallini, A., Legal, R. and Taboulet, F. (2013), The influence of drug use in university hospitals on the pharmaceutical consumption in their surrounding communities. British Journal of Clinical Pharmacology, 75: 1142–1148. doi: 10.1111/j.1365-2125.2012.04455.x
- Issue published online: 15 MAR 2013
- Article first published online: 15 MAR 2013
- Accepted manuscript online: 7 SEP 2012 06:05AM EST
- Manuscript Accepted: 2 SEP 2012
- Manuscript Received: 24 JAN 2012
- drug policy;
- drug utilisation;
- hospital-primary care interface;
- prescribing patterns
To investigate the influence of hospital drug choices on pharmaceutical consumption for nine competitive classes in the surrounding community.
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.
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.
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.