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Medical practices can benefit from specific policies for interacting with pharmaceutical representatives

Drug companies spend more than $13,000 per physician each year (a total of $10 billion) on drug promotion. Physician approaches for meeting with drug company representatives vary from random encounters to formal policies. They also vary in how they dispense drug samples and control access to them. Most physician practices could do a better job of managing office visits with drug company representatives, instituting specific policies for dispensing samples, and improving accountability for handling samples in the office, concludes a study supported by the Agency for Healthcare Research and Quality (HS08776).

Benjamin F. Crabtree, Ph.D., of the University of Medicine and Dentistry of New Jersey, and his colleagues used detailed descriptions from direct observations of 53 primary care clinicians and nearly 1,600 patient encounters in 18 Nebraska family practices to examine doctor-drug representative interactions. Use of medication samples varied from doctor to doctor, but on average, samples were given in nearly one of every five patient visits. Drug samples given most often were analgesics, antibiotics, anti-inflammatory drugs, and antihypertensives. Multiple drugs were dispensed in 15 percent of encounters, and in only 5 percent of cases was medication dispensed in response to a patients specific request. Drug samples were even offered for other family members in nearly 4 percent of encounters, especially in rural practices.

Doctors used the samples to test for efficacy and tolerance, provide temporary relief or convenience to the patient, or to save medication costs for poorer patients. Doctors gave patients instructions about drug use (usually dosing) in 48 percent of cases, with little additional information, such as whether the medication should be taken with meals or potential drug interactions. Some office personnel used the samples, and in one office, concern was expressed about patients having unsupervised access to drug samples. Formal strategies and policies regarding drug representative interactions and the use of samples were in place in only 8 of the 18 practices studied (44 percent), usually specifying a given time, such as lunch hour, to meet with the representatives. Gifts to the doctors from representatives varied from pens and candy to meals and theater tickets.

See "The value of pharmaceutical representative visits and medication samples in community-based family practices," by Elisabeth L. Backer, M.D., Jason A. Lebsack, Reinier J.N. Van Tonder, M.D., and Dr. Crabtree, in the September 2000 Journal of Family Practice 49(9), pp. 811-816.

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