Anaesthesia drug cost, control and utilization in Canada

  • Gareth S. A. Kantor
  • Frances Chung
Reports of Investigation

Abstract

Purpose

To investigate the attitudes of senior anaesthetists toward issues of anaesthesia drug cost control, utilization, and education, and to determine patterns of drug use of common clinical scenarios.

Methods

A questionnaire mailed to heads of anaesthesia departments in all large (> 200 beds) Canadian hospitals (n = 187). Data were analyzed with chi-square and t tests; P < 0.05 was considered significant.

Results

Sixty-eight per cent responded to the questionnaire. Ninety-four per cent considered cost when choosing anaesthetic agents, 63.7% indicated cheaper drugs could be used without decreasing quality of care, and 46.3% that restricted access to expensive agents was justified. Only 32.8% of hospitals currently imposed restrictions. Departmental practice guidelines were favoured by 82.1% of respondents. Fifty-three per cent considered resident education about drug cost to be inadequate, and 57.4% indicated that resident teaching justified the use of expensive agents. Most respondents (69.8–96.8%) felt they knew the cost of commonly used agents, many made considerable use of cheaper agents such as halothane, curare and morphine, and 61% re-used syringes containing residual drug. A few differences between teaching and non-teaching hospitals anaesthetists were identified.

Conclusions

These anaesthetists demonstrated awareness of pharmacoeconomic issues, believed that cheaper anaesthetic agents could be used without compromising quality of care, identified few hospitals with policies that restricted drug use, ssand indicated drug cost education could be improved. Control and responsibility of drug utilization were shared within their hospitals. Many approved the idea of practice guidelines. In common clinical scenarios cheaper agents were preferred and syringe re-use was surprisingly common.

Key words

anaesthesia: costs 

Résumé

Objectif

Discuter de l’attitude des anesthésistes en exercice au regard des agents anesthésiques en ce qui concerne les coûts, le contrôle, leur utilisation et l’approche pédagogique et déterminer leur façon de tes utiliser dans des situations cliniques habituelles.

Méthode

Un questionnaire a été expédié par la poste aux chefs de départements de tous les hôpitaux canadiens de plus de 200 lits (n = 187). Les réponses ont été analysées avec le tests chi au carré et T: P < 0,05 était considéré comme significatif.

Résultats

Soixante-huit pour cent ont répondu. Quatre-vingtquatre pour cent considèrent le coût lors du choix d’un anesthésique, 63,7% ont répondu que des produits moins coûteux pouvaient être utilisés sans diminuer la qualité des soins et 46,3 sont en faveur de restreindre l’accès aux produits dispendieux. Actuellement, seulement 32,8% des hôpitaux imposent des restrictions. Des directives issues du département sont préférées par 82,1% des répondants. Cinquantetrois pensent que la formation des résidents quant aux coûts agents est insuffisante, et 57,4% que l’enseignement en soi justifié l’usage des agents dispendieux. La plupart des répondants (69,8–96,8%) pensent connaître le coût des agents usuels, mais plusieurs utilisent des agents moins coûteux comme l’halothane, le curare et la morphine et 61% réutilisent les seringues contenant les surplus. Quelques différences ont été notées entre les hôpitaux d’enseignement et les autres hôpitaux.

Conclusion

Ces anesthésistes démontrent leur intelligence de la pharmacoéconomie, croient que des agents anesthésiques de moindre coût peuvent être utilisés sans compromettre la qualité des soins, ne constatent des politiques restrictives que dans un petit nombre d’hôpitaux et pensent que l’enseignement pourrait être amélioré quant aux coûts. Plusieurs manifestent leur accord aux directives d’exercice. Dans les situations courantes, les agents moins chers sont préférés et la réutilisation des seringues se pratique de façon déconcertante.

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Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Gareth S. A. Kantor
    • 1
  • Frances Chung
    • 1
  1. 1.Department of AnaesthesiaToronto Hospital (Western Division)TorontoCanada

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