Achieving Quality Care and Cost Containment

In some cases, the level of use of antibiotics for patients who need them is being reduced as a result of increased pressures to reduce costs. Not only does this breed patient dissatisfaction, but also, most importantly, this activity may compromise the quality of health care and thereby increase incidences of infection. New strategies are required to realize cost savings from lower levels of antibiotic use as a result of formulary management decisions, such as conducting benchmarking studies and developing an iterative computerized system to help track antimicrobial resistance.

Health care policies that provide efficient and swift dissemination of information on new uses of drugs, and that provide guidance on the promotion of medical products in the managed care environment should be implemented. Additionally, workshop participants proposed that, after controlling for severity of illness, minimization of costs and services can be attained while simultaneously controlling costs. This line of argument leads to discussions about the use of databases as a tool for achieving such results by taking into account several patient factors. Databases can help determine which management strategies, interventions, and medications are most appropriate for the provision of better treatment outcomes on the basis of the patient's needs. Although the traditional method of using diagnostic codes provides only a vague description of symptoms, the database methodology encourages health care systems (including managed care settings, hospitals, long-term care facilities, and ambulatory-care settings) to provide services outside their traditional roles and allow patients' conditions to be identified more readily. By obtaining a more accurate picture of a patient's condition, physicians can better ascertain the patient's ailment and thus be in a better position to treat the symptoms. In turn, this may translate into cost savings, in addition to an increased quality of care and faster care.


Discussions of the preliminary data on drug formularies suggested that formulary restrictions fail to control the overall costs of health care or to improve the quality of care. The drugs available in formularies vary widely among providers. With respect to infectious diseases, however, it appears that formulary restrictions—particularly the monopolistic use of a few broad-spectrum drugs—may actually contribute to the emergence of antibiotic resistance. Better data are still needed on these issues, for in the absence of these data, providers may likely continue to base formulary decisions primarily on cost instead of on the desire to improve the quality of care and to limit the spread of antibiotic resistance.

The panelists thought that it would be desirable to allow physicians to prescribe a greater variety of antibiotics, especially narrow-spectrum drugs, and when trying to treat infections caused by specific microorganisms to adjust the dosage and duration of therapy to match the needs of particular patients. Several

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