Given the worldwide drive to control rapidly rising health care costs and manage diminishing resources, it seems surprising that wet nebulizers (WNs) continue to be widely regarded as first-line delivery devices, despite repeated demonstrations that metered-dose inhalers (MDIs) especially when combined to a holding chamber (HC) are almost always equivalent in treating adults and children in most settings. Only few indications remain for nebulizers use whereas we witness in practice so many inadequate or unjustified prescriptions. This study aims at establishing the amount of these false prescriptions, and at demonstrating their effects on costs, time consumption for healthcare workers and side effects for the patients.
All the departments of a university hospital (386 beds) were reviewed during 48 hours for WN prescriptions and these were evaluated for adequacy. Costs were calculated on a mean duration of hospital stay basis and on a yearly basis.
The study population included 705 patients, of which 89 (12.6%) had an obstructive respiratory disease. Among that population, 128(18.2%) were treated by WN, of which only 41(5.8%) had a justified indication. As for the costs, we calculated that the patient paid $172.79 for the WN treatment during a 7.81-days mean hospital stay. An estimate of the mean total hospital bill in 2008 was $2,363.34 of which 28% were due to WN therapy. The yearly amount of money spent “uselessly” for inadequately prescribed WN treatments was $48,065.44. It was also established that the “lost” time by the therapist (if one therapist was to administer all those inadequately prescribed treatments) was approximately 2178.84 hours yearly, representing a total loss of one year and 10 weeks of working 40 hours a week. Very few side effects were noted.
There is noticeable abuse in the prescription of WN therapy.
Misuse of nebulizer therapy is particularly alarming regarding costs and time consumption and should be addressed with the appropriate strategies for change.
Moussa Riachy, No Financial Disclosure Information; No Product/Research Disclosure Information