General practitioners and pharmaceutical sales representatives: quality improvement research.
OBJECTIVE
Interaction between pharmaceutical sales representatives (PSRs) and general practitioners (GPs) may have an adverse impact on GP prescribing and therefore may be ethically questionable. This study aimed to evaluate the interactions between PSRs and GPs in an Australian general practice, and develop and evaluate a policy to guide the interaction.


METHODS
Doctors' prescribing, diaries, practice promotional material and samples were audited and a staff survey undertaken. After receiving feedback, the staff voted on practice policy options. The resulting policy was evaluated 3 and 9 months.


RESULTS
Prior to the intervention, GPs spent on average 40 min/doctor/month with PSRs. There were 239 items of promotional material in the practice and 4660 tablets in the sample cupboard. These were reduced by 32% and 59%, respectively, at 3 months after policy adoption and the reduction was sustained at 9 months. Vioxx was the most common drug name in promotional material. Staff adopted a policy of reduced access to PSRs including: reception staff not to make appointments for PSRs or accept promotional material; PSRs cannot access sample cupboards; GPs wishing to see PSRs may do so outside consulting hours. At 3 and 9 months, most staff were satisfied with the changes. Promotional items/room were not significantly reduced at 3 months (-4.0 items/room ; 95% CI -6.61 to -1.39; p = 0.066) or 9 months (-2.63 items/room; 95% CI -5.86 to 0.60; p = 0.24). Generic prescribing significantly increased at 3 months (OR 2.28, 95% CI 1.31 to 3.86; p = 0.0027) and 9 months (OR 2.07, 95% CI 1.13 to 3.82; p = 0.016).


CONCLUSIONS
There was a marked reduction in interactions with PSRs with majority staff satisfaction and improved prescribing practices. The new policy will form part of the practice's orientation package. Reception staff give PSRs a letter explaining the policy. It is hoped that the extra 40 min/doctor of consulting time translates into more time with patients and time to evaluate more independent sources of drug information.
Spurling
Geoffrey
G
Discipline of General Practice, University of Queensland, Queensland, Australia. g.spurling@uq.edu.au
Mansfield
Peter
P
D001315:Australia; D004345:Drug Industry / Q000191:economics*; D017723:Drug Utilization Review; D005194:Family Practice / Q000941:ethics / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D040541:Marketing; D011050:Policy Making; D011216:Practice Management, Medical / Q000941:ethics / Q000592:standards*; D013997:Time Factors; D017749:Total Quality Management
BMJ. 2000 Nov 4;321(7269):1138-40
11061740
JAMA. 1995 Apr 26;273(16):1296-8
7715044
Br J Gen Pract. 1994 May;44(382):220-3
8204336
J Gen Intern Med. 2000 Jul;15(7):478-83
10940134
Arch Fam Med. 1996 Apr;5(4):201-6
8769907
BMJ. 2001 Aug 18;323(7309):378-81
11509431
Eur J Clin Pharmacol. 1994;46(6):501-5
7995315
JAMA. 1998 Jun 3;279(21):1698-9
9624016
Can Fam Physician. 1997 May;43:941-5
9154366
PLoS Med. 2006 Nov;3(11):e451
17090212
Eur J Public Health. 2002 Sep;12(3):187-91
12232957
BMJ. 2003 May 31;326(7400):1189-92
12775621
Fam Pract. 2001 Feb;18(1):21-6
11145623
Qual Saf Health Care. 2003 Feb;12(1):29-34
12571342
Int J Health Serv. 1998;28(2):269-79
9595344
Ann Fam Med. 2005 Jan-Feb;3(1):82-5
15671196
Pharm World Sci. 2006 Oct;28(5):302-8
17111244