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Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?

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ABSTRACT

CONTEXT

Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician–trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs).

OBJECTIVE

To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions.

DESIGN, SETTING, AND PARTICIPANTS

Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings.

RESULTS

Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings.

CONCLUSIONS

Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring the current primary care model and offering convenient, individualized, non-biased educational options may aid success.

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Acknowledgments

We gratefully acknowledge the time and effort spent assisting with coordination and recruitment of participants from various people at the following organizations: Dartmouth Hitchcock Medical Center, Lovelace Medical Group, Nurse Practitioner Associates for Continuing Education (NPACE), Physician Assistant Academy of VT (PAAV), UMMHC Community Medical Group, and UMMS Clinical Faculty Development Center.

Funding/Support

This work was funded by the Attorney General Consumer and Prescriber Grants Program.

Role of the Sponsors

The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Author Contributions

Dr. Fischer had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis.

Study concept and design: Fischer, Keough, Mazor, Baril, Gurwitz.

Acquisition of data: Fischer, Keough, Saccoccio, Von Worley.

Analysis and interpretation of data: Fischer, Mazor, Keough, Baril, Ladd.

Drafting of the manuscript: Fischer, Keough.

Critical revision of the manuscript for important intellectual content: Fischer, Keough, Baril, Saccoccio, Mazor, Ladd, Von Worley, Gurwitz.

Statistical analysis: Fischer, Baril.

Administrative, technical, or material support: Keough, Baril, Saccoccio, Von Worley.

Study supervision: Fischer, Keough, Gurwitz.

Other (qualitative methodology): Mazor, Ladd.

Financial Disclosures and Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. University of Massachusetts Medical School (UMMS), 55 Lake Ave N, Worcester, MA, 01655, USA

    Melissa A. Fischer MD, MEd, Mary Ellen Keough MPH, Joann L. Baril BS, Laura Saccoccio BS, Kathleen M. Mazor EdD & Jerry H. Gurwitz MD

  2. Meyers Primary Care Institute (MCPI), Worcester, MA, USA

    Melissa A. Fischer MD, MEd, Mary Ellen Keough MPH, Joann L. Baril BS, Laura Saccoccio BS, Kathleen M. Mazor EdD & Jerry H. Gurwitz MD

  3. Fallon Community Health Plan, Worcester, MA, USA

    Mary Ellen Keough MPH, Joann L. Baril BS, Laura Saccoccio BS, Kathleen M. Mazor EdD & Jerry H. Gurwitz MD

  4. Fallon Clinic, Worcester, MA, USA

    Mary Ellen Keough MPH, Joann L. Baril BS, Laura Saccoccio BS, Kathleen M. Mazor EdD & Jerry H. Gurwitz MD

  5. MGH Institute of Health Professions, Boston, MA, USA

    Elissa Ladd PhD, RN, FNP

  6. Lovelace Clinic Foundation, Albuquerque, NM, USA

    Ann Von Worley RN, BS, CCRP

Authors
  1. Melissa A. Fischer MD, MEd
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  2. Mary Ellen Keough MPH
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  3. Joann L. Baril BS
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  4. Laura Saccoccio BS
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  5. Kathleen M. Mazor EdD
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  6. Elissa Ladd PhD, RN, FNP
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  7. Ann Von Worley RN, BS, CCRP
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  8. Jerry H. Gurwitz MD
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Corresponding author

Correspondence to Melissa A. Fischer MD, MEd.

Additional information

This work was funded by the Attorney General Consumer and Prescriber Grants Program.

Appendix: Focus Group Questions

Appendix: Focus Group Questions

1.

How do you learn new information or maintain your knowledge of pharmaceuticals? By this I mean new drugs, new indications for established drugs, new side effect or risk information?

2.

Please tell me about your exposure to drug marketing in the last week? Please be specific. Pharmaceutical representatives (called drug reps)? Journal advertising? DTC ads on TV/radio? Patient requests? Professional meetings? Educational presentations? Others? If there is little discussion probe - how about in the last month?

3.

Overall do you feel that interactions with drug reps help or hurt your patient care? Can you give specific examples? Why? How?

4.

What aspects of drug marketing, if any, do you find helpful, useful or informative? Why? How?

5.

What aspects of drug marketing, if any, do you personally find difficult to deal with? Why? How?

6.

Have you developed any particular strategies for dealing with drug marketing techniques that you have found helpful? Please be specific. How did you learn this technique? If they don’t come up probe: drug reps, DTC advertising, how about here at the conference?

7.

What sort of training or other support (including print or Web resources) would you need to better manage your interactions with drug reps or other pharmaceutical marketing?

8.

Please tell me about any workplace policies that regulate your interactions with pharmaceutical representatives? What are those policies? Are they enforced? How? How do they impact your interactions with representatives? Patient care? Overall do you feel they are helpful? Harmful? What else might you suggest?

9.

Any other information you would like to share on this topic?

10.

What do you think about the fact that drug reps can obtain data about your own prescribing habits? Have you ever received personal information about your own prescribing from a pharmaceutical representative? What impact did that have on your interaction? On your prescribing?

11.

When a choice exists, how do you decide to prescribe generic or prescription medication?

12.

Now I’d like you to think about any personal information you may have received from a pharmacist or health plan about formulary medications, prescribing or generic medications. What impact did that have on your prescribing?

13.

Can you talk about what happens when patients request specific medications based ads they have seen? What’s a typical interaction like when this occurs? Do you feel these patients share any characteristics? (e.g., age, sex, SES, health status, conditions, etc.)

14.

Please tell me about any HARD experiences you have had with a patient requesting a drug after seeing ads for it. What was most difficult?

15.

Please tell me about any experiences you have had where a patient requested a drug because of an ad which led to better care for the patient.

16.

How do you usually respond to a patient’s request for medications that are not clinically appropriate? What influences how you respond to these sorts of requests?

17.

Have you ever had training in how to respond to patient requests for specific advertised medications? What specific areas do you think such training should cover?

18.

What other support (including Web or print resources) would be helpful to you?

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Fischer, M.A., Keough, M.E., Baril, J.L. et al. Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?. J GEN INTERN MED 24, 795–801 (2009). https://doi.org/10.1007/s11606-009-0989-6

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