Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool.

Background: Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending.

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups.

Background: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines.

Objective: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care.

Methods: A database of 261,054 population in one health district of an Eastern region of Spain was used.

[A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain].

Background: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control.

Methods: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure.