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Abstract

The objective of this study was to investigate physicians' compliance with recommendations for drug substitutes embedded within an electronic medical record, to assess factors affecting compliance, and to evaluate associated cost savings. An exploratory study of all physicians in all clinics operated by a large health maintenance organization (HMO) was conducted using a transparent computerized agent that collected 1.21 million prescriptions prescribed by 647 physicians. Compliance with HMO recommendations for substitute drugs reached a 70 percent rate. Substitute type, whether generic or therapeutic, was found to be the most significant factor affecting compliance, with physician workload and age second and third in effect magnitude, respectively. Compliance was found to be non-automatic and selective, following a thoughtful cognitive process. The HMO realized at least a 4 percent reduction in costs for prescribed drugs as a result of compliance with substitute recommendations. The results can be interpreted via the lens of Organizational Justice Theory, assuming that the broad compliance with generic substitutes was driven by perception of just procedures, whereas there was no such perception in the case of therapeutic substitutes. While more research is warranted for investigating the motivations driving physicians' compliance, we strongly feel that the results can be generalized to other HMOs and healthcare settings.

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