title: Breaking up is hard to do: lessons learned from a pharma-free practice transformation.
abstract: BACKGROUND
  Academic medical centers are examining relationships with the pharmaceutical industry and making changes to limit interactions. Most doctors, however, practice outside of academic institutions and see pharmaceutical detailers and accept drug samples and gifts. Little guidance for practicing physicians exists about transforming practices to become pharma-free. Consideration must be given to the impact on practice culture, staff views, and patient needs.
  
  
  METHODS
  A small private practice, setting out to transform into a pharma-free clinic, used a practice transformation process that examined the industry presence in the clinic, educated the doctors on potential conflicts of interest, and improved practice flow. Staff were given the opportunity to share concerns, and their issues were acknowledged. Educational interventions were developed to help providers keep current. Finally, efforts were made to educate patients about the policy.
  
  
  RESULTS
  The clinic recorded the degree to which it was detailed. Loss of gifts, keeping current with new drugs, and managing without samples were noted concerns. Policy change champions developed strategies to address concerns.
  
  
  CONCLUSIONS
  A shift in practice culture to a pharma-free clinic is achievable and maintainable over time. Barriers to success can be identified and overcome with attention given to careful gathering of information, staff input, and stakeholder education.
authors: Department of Family Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA. evansd@uw.edu
authors: David
authors: D
authors: Evans
authors: Daniel M
authors: DM
authors: Hartung
authors: Denise
authors: D
authors: Beasley
authors: Lyle J
authors: LJ
authors: Fagnan
mesh_terms: D001291:Attitude of Health Personnel; D016265:Conflict of Interest / Q000331:legislation & jurisprudence*; D003363:Cost Control / Q000331:legislation & jurisprudence; D016527:Drug Costs / Q000331:legislation & jurisprudence; D004345:Drug Industry / Q000331:legislation & jurisprudence*; D005194:Family Practice / Q000331:legislation & jurisprudence; D037921:Gift Giving; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007318:Inservice Training; D040541:Marketing / Q000331:legislation & jurisprudence*; D009922:Oregon; D011216:Practice Management, Medical / Q000331:legislation & jurisprudence; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence*; D014481:United States
keywords: Conflict of Interest; Drug Industry; Medical Ethics; Practice Management