Friday, May 24, 2013

Running a Pharm-Free Office: One Group's Story

Recently I posted on a report suggesting that drug reps were having a harder time getting in to see docs:

For background on why this is so, in at least one family practice in Oregon, we can turn to an article by Dr. David Evans and colleagues:

Dr. Evans describes how a 7-person practice (6 physicians and a PA) started in 2005 to make the transition to pharm-free. At the start, providers were divided on the wisdom of such a move and stafff complained that they'd miss the free lunches, samples, and free office items that the reps provided.

The practice began by quantifying the current level of influence of reps on the practice. They noted an average of 33 visits per month and 2.3 lunches per month. They also checked out the sample cupboard and noted hardly any first-line drugs for treating any common condition; instead they found drugs that would cost an average of $90/mo while the ideal generic substitute would have cost an average of $22/mo. These figures helped persaude the resistant members of the group on the value of making the transition away from reps (the new pharm-free policy went into effect in 2006).

The group next addressed the absence of the reps' talks for drug updates. They developed a process for holding staff meetings with evidence-based assessments of new pharmaceuticals. They also invested in regular staff lunches so that the social activities were not curtailed.

Finally the practice announced its new policy to the local media, garnering favorable publicity. No patients complained of the new policy and the community response was generally laudatory.

Dr. Evans and co-authors noted the general absence of similar accounts in the literature applicable to rural primary care practices, and offer their experience as one possible template for implementing change.

I would add that while the Oregon group did not mention it, a practice that wished to take the same steps might be helped by the materials provided by the National Physicians Alliance's Unbranded Doctor campaign:


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Michael S. Altus, PhD, ELS said...

Recalling my reply to your February 10, 2011, blog entry, “Cutting the Gordian Knot: Legal Ban on Gifts/Bribes?”:

But imagine if a physician who is grateful to a pharmaceutical company representative offers educational materials such as expensive books, pens, notepads, coffee cups, and expensive meals. According to the stated ethical positions of pharmaceutical companies, the reps could not accept. For example, The Blue Book--Summary of Pfizer Policies on Business Conduct ( states on page 33, “Gifts, Entertainment and Other Items of Value--The Company prohibits you and your immediate family from giving and accepting gifts, services, perks, entertainment, discounts, loans or other items of more than modest value by local standards, to or from those who are doing business or seeking business with the Company. Items of modest value are permitted only if they are not given or received on a regular or frequent basis....”

The unblinking hypocrisy is galling.