title: Counter sampling combined with medical provider education: do they alter prescribing behavior?
abstract: OBJECTIVE
  To observe if medical providers alter their prescribing patterns of three relatively expensive categories of medications provided as samples by manufacturers (focus medications) when they receive additional education from pharmacists concerning the appropriate use of lower cost alternatives (counter samples) that are made available to dispense.
  
  
  METHODS
  Pretest, post-test with a control group.
  
  
  METHODS
  Two rural, private care clinics in southeastern Idaho providing immediate care services.
  
  
  METHODS
  Eight medical providers at a clinic where interventions were employed (active intervention group) and seven medical providers in a clinic where no interventions occurred (control group).
  
  
  METHODS
  Medical providers in the active intervention group had: 1) education from pharmacists concerning the appropriate use of lower-cost alternatives compared with expensive focus medications 2) counter samples and patient sample handouts available to dispense to patients at their own discretion.
  
  
  METHODS
  The percentage of the total yearly prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and acid-relief medications that consisted of focus-COX-2 NSAIDs, nonsedating antihistamines, and proton pump inhibitors (PPIs), respectively.
  
  
  RESULTS
  The prescribing behavior of medical providers in the active intervention and control groups were significantly different at baseline in all three categories of focus medications. This suggested that the results should focus on changes across the two years of the study within the intervention and control groups rather than across the two groups. Medical providers in the intervention group significantly decreased the use of COX-2 NSAID prescriptions relative to total NSAID prescriptions following active intervention (38.9% in year 1 versus 23.7% in year 2, P < 0.05). Over the same two time periods, a nonstatistically significant decrease in COX-2 NSAID prescribing was seen at the control site (67.5% versus 62%, P > 0.05). Education and counter sampling did not stop medical providers from significantly increasing the total yearly prescriptions for antihistamines and acid-relief medications that consisted of focus-nonsedating antihistamines (86.7% versus 93.1%, P < 0.05) and PPIs (68.9% versus 86.2%, P < 0.05). Statistically significant increases in the prescribing of focus-nonsedating antihistamines (77.9% versus 98.3%, P < 0.05) and PPIs (77.5% versus 91.4%, P < 0.05) were also observed in the control group.
  
  
  CONCLUSIONS
  Education by pharmacists, combined with access to counter samples, may or may not have an effect on medical provider prescribing, depending on the category of medication targeted for cost control.
authors.affiliation: Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Pocatello 83209-8333, USA. johnerra@pharmacy.isu.edu
authors.forename: John
authors.initials: J
authors.lastname: Erramouspe
authors.forename: Jason M
authors.initials: JM
authors.lastname: Bailey
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Cleveland
authors.forename: Kerry
authors.initials: K
authors.lastname: Casperson
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Hunt
authors.forename: Paul S
authors.initials: PS
authors.lastname: Cady
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000191:economics; D017046:Cost Savings / Q000379:methods*; D016527:Drug Costs; D004363:Drug Utilization; D004502:Education, Medical, Continuing / Q000191:economics / Q000458:organization & administration*; D039563:Histamine H1 Antagonists, Non-Sedating / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D054328:Proton Pump Inhibitors; D019035:Rural Health Services / Q000458:organization & administration
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D039563:Histamine H1 Antagonists, Non-Sedating; D054328:Proton Pump Inhibitors