The impact of a disease management intervention on the treatment of infectious disease in a managed care organization

The purpose of this study was to examine the implications of a disease management intervention in treating patients with infectious diseases, in terms of both drug and medical resources and the costs associated with those resources. A managed care organization introduced a treatment guideline that was designed to influence the pattern of antibiotic prescribing by providers. The primary intervention was the promotion of treatment guidelines through mailings and face-to-face interventions by two disease management specialists. A relational database was created to assess changes in healthcare resource consumption, antibiotic use, and their respective costs. All patients being treated for the eight most common ambulatory infectious diseases were included. One year of data before and after promoting the treatment guideline was compared to assess the changes in medical and antibiotic resources and costs. The study demonstrated that there were important changes in antibiotic prescribing toward those antibiotics on the treatment guideline. However, the net effect was an increase in antibiotic and medical costs on a per member per month basis after the treatment guidelines were implemented. Analysis of antibiotic prices indicated that if antibiotic costs would have remained constant, the shifts in antibiotic patterns would have resulted in a reduction in total antibiotic costs. This study demonstrates that promotion of an infectious disease treatment guideline is effective in altering prescribing behavior. However, changes in drug prices or use of certain expensive products can overwhelm cost savings from other products.