Aims: To investigate the effect of guidelines and supervision of the prescription of antimicrobial agents at Reykjavik Hospital on the cost and the amount used of these agents.
Material and methods: The investigation was conducted from 1994 to 1997. Guidelines were issued for the prescription of antimicrobial agents in empirical treatment and for prophylactics in surgery. The availability of these agents was reduced and the physicians had to order these drugs by filling out a special application form. These forms were later on used for the supervision by a pharmacist and an infectious disease physician of the use of antmicrobial agents and to monitor any change in the prescription of the agents. If needed the supervisors gave advice to the clinicians responsible for the patients care. The supervision took place at eight of the wards of the hospital and started at different times during May 1995 to March 1996.
Results: The cost of the usage of antimicrobial agents was reduced after the introduction of the supervision. However, as time passed from the implementation of the supervision the cost tended to increase again. The greatest cost reduction was achieved at the departments of surgery or 8.5 million Icelandic crowns. At the departments of medicine the cost reduction was 2.3 million crowns. By correcting for the cost of supervisory staff the real cost decrease was approximately 6 million crowns. The total amount of prescribed antimicrobial agents measured by the Standardised Daily Dosage was reduced in all the concerned wards by 3-14%.
Conclusions: The real cost decreases after the implementation of supervision of the prescription of antimicrobial agents was approximately six million Icelandic crowns during 1994 to 1997. Also, the proportion of antimicrobial agents in the total cost of drugs was reduced after the supervision started in spite of increasing mean cost per Standardised Daily Dosage increased at the departments during the study period. The goal of reducing the amount of antimicrobial agents prescribed was also achieved.