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: http://npalliance.org/action/the-unbranded-doctor/