E-drug: General practitioners and pharmaceutical industry info
-------------------------------------------------------------------------
BMJ 326:1178-1179 (31 May 2003)
Characteristics of general practitioners who frequently see drug
industry representatives: national cross sectional study
Chris Watkins, Laurence Moore, Ian Harvey, Patricia Carthy,
Elizabeth Robinson, Richard Brawn
Correspondence C Watkins chris.watkins@Bristol.ac.uk
Variation in prescribing costs between general practitioners is well
documented.1 We previously found that frequent general
practitioner contact with drug industry representatives was strongly
and independently associated with higher prescribing costs.2 This
paper describes the attitudes and behaviour of general
practitioners who report seeing drug representatives frequently.
We sent a questionnaire to all general practitioners in 200 English
practices randomly selected from three groups defined as the
bottom, middle, and top fifths of prescribing costs. The
questionnaire elicited general practitioners' personal and practice
characteristics and their agreement with a series of statements
about their prescribing attitudes and behaviour. Full details of the
methods have been published.2
In all, 1097 of the 1714 general practitioners (64%) responded. We
included the responses to each statement in a set of univariable
logistic regression models in which the dependent variable was
whether the general practitioner reported seeing drug
representatives at least once a week. The table shows the
statements that were significant (P < 0.05) in the univariate
analysis. We entered these variables into a multivariable logistic
regression model together with nine general practitioner and
practice variables. This model found that frequent contact with a
drug representative was significantly associated with a greater
willingness to prescribe new drugs and to agree to patients'
requests to prescribe a drug that is not clinically indicated,
dissatisfaction with consultations ending in advice only, and
receptiveness to drug advertisements and promotional literature
from drug companies (table).
Odds ratios of general practitioners seeing drug industry
representatives at least once a week in univariable and adjusted
multivariable logistic regression models
General practitioners who report weekly contact with drug
representatives are more likely to express views that will lead to
unnecessary prescribing than those who report less frequent
contact. Little et al showed that prescribing antibiotics rather than
giving advice on self management of sore throat can result in
increased workload for general practitioners, through repeat
attendance.4 Using Little et al's data, Marshall calculated that if a
general practitioner prescribed antibiotics for sore throat to 100
fewer patients every year, 33 fewer would believe antibiotics were
effective, 25 fewer would intend to consult with the problem in the
future, and 10 fewer would come back within the next year.5 If
some general practitioners' reluctance to end consultations without
prescribing extends to other self limiting conditions, the effect on
reattendance rates and thus workload could be substantial.
Perhaps this is why general practitioners who see drug
representatives most often report experiencing the most
consultations when they feel under pressure of time.
When new drugs became available, general practitioners who saw
drug representatives at least weekly were more likely, as their first
course of action, to prescribe them for a few patients and monitor
the results. This conflicts with the advice given by health
commissioners to use published sources of evidence such as the
British National Formulary.
General practitioners who see drug representatives most often
tend to be those who are isolated from their colleagues
(singlehanded practitioners and those uninvolved in general
practitioner training) and to work in deprived areas. For some
general practitioners, the frequency of contact must be greater than
their need to know more about new drugs. Such visits possibly fulfil
a pastoral rather than an educative role.
This cross sectional analysis cannot identify the direction of
causality. Indeed, the observed associations may be due both to
frequent drug representative contact leading to attitudes and
behaviour associated with higher cost prescribing and to drug
representatives targeting those general practitioners known to have
more responsive attitudes or to be high cost prescribers. More
research on the nature of this relationship would help primary care
trusts to adopt policies encouraging more cost effective
prescribing.
Audit Commission. A prescription for movement towards more
rational prescribing in general practice. London: Audit Commission,
1996: 9-12.
Watkins C, Harvey I, Carthy P, Moore L, Robinson, E, Brawn P.
The attitudes and behaviour of general practitioners and their
prescribing costs: a national cross sectional survey. Quality and
Safety in Healthcare (in press).
Lloyd DCEF, Harris CM, Clucas DW. Low income scheme index: a
new deprivation scale based on prescribing in general practice.
BMJ 1995;310: 165-70.
Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL.
Reattendance and complications in a randomised trial of
prescribing strategies for sore throat: the medicalising effect of
prescribing antibiotics. BMJ 1997;315: 350-2.
Marshall T. Reducing unnecessary consultation a case of NNT?
Bandolier 1997;44(4) 1-3.
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug