After years of reducing their contact with pharmaceutical sales
representatives, physicians now risk an unintended consequence: Doctors who
rarely meet with pharmaceutical sales representatives — or who do not meet with
them — are much slower to drop medicines with the Food and Drug
Administration's "black box" warnings and to adopt first-in-class
therapies.
According to a study published May 21 in The Journal of Clinical
Hypertension, doctors whose access to pharmaceutical sales representatives
is limited can take more than four times longer to change prescriptions based
on new information than their peers who have more frequent contact. This longer
response time holds true whether the physicians are responding to
"positive news" related to an innovative therapy or "negative
news" related to a newly discovered medicine risk.
George Chressanthis, professor of healthcare management and marketing and
acting director for the Center for Healthcare Research and Management at Temple
University's Fox School of Business, led the study in collaboration with ZS
Associates, a global sales and marketing consulting firm with a very deep
presence in the health care industry.
"This study analyzed for the first time — and on a large scale — what
happens to physicians' prescription decisions when you decrease the access that
pharmaceutical sales reps have to doctors," Chressanthis said. "We
saw that increasing access restrictions affect physician decision-making in
ways not anticipated by those at health care systems or large group practices
who created these policies."
Chressanthis, his research team and ZS consultants began to measure the
behavior of primary care physicians and specialists in 2008 when Chressanthis
was at AstraZeneca Pharmaceuticals LP. They drew from ZS' annual AccessMonitor™
report, which since 2006 has tracked how frequently 300,000 physicians and
other prescribers meet with pharmaceutical sales reps. According to
AccessMonitor™, the number of doctors willing to see reps has declined about 20
percent since 2008. In 2010, about 11 percent of American physicians had
"severe" or "no-see" restrictions on rep access, while 34
percent had "some" restrictions.
The study measured prescription activity and behavior by primary care
physicians and specialists from 2006-2008 as it related to the following three
major product events:
- The October 2006 launch of a first-in-class drug to treat Type 2 diabetes (sitagliptin) (physician sample size: 65,088);
- the August 2007 issue of a black box warning (i.e., the FDA's most serious medication warning) for a drug (rosiglitazone) used to treat Type 2 diabetes (physician sample size: 58,647); and,
- the January 2008 release of a negative outcome associated with a therapy that combined a cholesterol-lowering drug (simvastatin) and another medicine (ezetimbe) to treat dyslipidemia (physician sample size: 72,114).
In the case of sitagliptin, physicians with a "very low" level of
sales rep access took up to 4.6 times longer to introduce the new drug to
patients than physicians who employed a "medium" level of access. For
the black box warning, physicians with "very low" access were up to
four times slower to reduce their use of this treatment than physicians with
"low" access. In the clinical trial involving the negative outcomes
of a lipid therapy prescription, physicians who limited sales rep access showed
"significantly less" response in changing their patients' prescriptions
than did physicians in less restrictive offices.
ZS managing principal Pratap Khedkar, co-author of the study, said the
research demonstrated that most physicians should seek to balance their
information sources.
"Though health care professionals work hard to minimize distractions
and maximize the time they spend with patients, it's clear that sales rep
access restrictions imposed by well-meaning physicians and group practice
leaders can result in serious information gaps," Khedkar said. "Even
though pharmaceutical sales representatives are not the only source of
information, they do help physicians stay current on therapy developments.
These findings should be carefully considered by those who set policy — whether
it's at the physician group practice level or on the national stage."
The study also showed primary care physicians rely more heavily on sales
reps for drug information than do specialists. "When primary care
physicians reduce or eliminate contact with these reps, it impairs their
ability to stay current and affects their prescription behavior," Khedkar
said. "Because specialists concentrate in a narrow field, they can stay
current by other means, including conferences, online forums, podcasts and
academic journals. Thus, the updates they receive from reps have less impact on
their prescribing abilities."
Chressanthis provides these final notes about the importance of this study.
"Our study affirms simple intuition that when physicians have to make
decisions involving complex issues with less than complete information
available to them, and where the consequence of a wrong decision is significant
as seen often in healthcare, unintended consequences are likely to
appear," he said. "Policies that promote physician ignorance of new
medical information resulting from access limits runs counter to protecting
patient health."