Hospital Pharmacy - June 2018 - 188

739005
research-article2017

HPXXXX10.1177/0018578717739005Hospital PharmacyHammond et al

Article

Nonpharmacist Health Care Providers'
Knowledge of and Opinions Regarding
Medication Costs in Critically Ill Patients

Hospital Pharmacy
2018, Vol. 53(3) 188-193
© The Author(s) 2017
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https://doi.org/10.1177/0018578717739005
DOI: 10.1177/0018578717739005
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Drayton A. Hammond1, Tiffany Chiu2, Jacob T. Painter3,
and Nikhil Meena3

Abstract
Purpose: Medication cost is frequently overlooked when treating critically ill patients. Stewardship of health care resources
in high-utilization settings is imperative. This study was conducted to determine nonpharmacist health care providers'
knowledge and perceptions of medication costs in a medical intensive care unit (MICU). Methods: Nonpharmacist health
care providers in a MICU completed a 27-item survey. The survey queried perceptions regarding medication cost, costlimiting strategies, and most/least expensive medications in 8 classes, medication price ranges, and intravenous-to-oral
comparisons for commonly prescribed medications. Responses were analyzed using descriptive statistics and compared
between providers using Fisher exact tests. Results: Among 98 health care providers (76 medical trainees, 5 attending
physicians, 17 nurses), when ordering a medication, 49% consider its cost. Few (15%) providers considered themselves
knowledgeable regarding medication costs with no difference between providers (P = .174). Attending physicians were more
aware of the most/least expensive medications than residents (correct out of 16: 9.6 vs 8.5, P = .044). The correct price
ranges for select medications (11%-36%, P = .373) and intravenous-to-oral relative costs (3%-49%, P = .596) were similarly
low. Most (59%) believed pharmacists limit expensive medication use, particularly senior physicians (58% resident vs 100%
attending, P = .007). Conclusion: In spite of a goal of cost consideration, most nonpharmacist health care providers are
unaware of medication costs and fail to include them in decision making. These knowledge gaps and perceptions should
inform future efforts to improve knowledge and attitudes regarding medication costs.
Keywords
cost, critical care, pharmacist/physician issues

Introduction
The consistent growth in health care expenses remains a
national concern. In 2015, health care expenses accounted
for approximately 18% of the United States' gross domestic
product, representing a greater contribution than any other
country.1 Health care expenditures increase substantially
when a patient receives care in the intensive care unit
(ICU),2,3 with costs for inpatient care in the final 30 days of
life showing a more than 15-fold increase compared with the
first 30 days of the final year of life.4 When prescribing medications, many factors are evaluated, but too often is the cost
of medication overlooked with the financial burden ultimately falling on the patients or their family. Currently, there
are many physician associations (eg, American College of
Physicians, American Board of Internal Medicine, and
Alliance for Academic Internal Medicine) providing educational programs on cost-conscious, high-value care.5,6 A key
feature to providing cost-conscious care is improving health
care providers' awareness of the relative and absolute costs

of medications. Although pharmacists have a unique skill set
that includes an awareness of the costs of most medications
used in their patients, neither of these programs addresses the
pharmacist as a resource in the process of providing costconscious care.
Knowledge transmission, reflective practice, and a supportive environment were found to aid in the development of
future physicians who were trained to provide high-value,
cost-conscious care.7 In organizations where a culture of
high-value, cost-conscious care is not engrained in its
employees, an early step in the process of changing the
1

Rush University Medical Center, Chicago, IL, USA
CoxHealth, Springfield, MO, USA
3
University of Arkansas for Medical Sciences, Little Rock, USA
2

Corresponding Author:
Drayton A. Hammond, Clinical Pharmacy Specialist, Medical Intensive
Care, Department of Pharmacy, Rush University Medical Center, 1653 W
Congress Parkway, Chicago, IL 60612, USA.
Email: drayton_hammond@rush.edu
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