Pharmaceutical Detailing Research Articles

Experience of VA Psychiatrists With Pharmaceutical Detailing of Antipsychotic Medications

Experience of VA Psychiatrists With Pharmaceutical Detailing of Antipsychotic Medications

Experience of VA Psychiatrists With Pharmaceutical Detailing of Antipsychotic Medications

The interaction between physicians and the pharmaceutical industry has become a subject of increased interest and concern. This study surveyed a national sample of psychiatrists practicing within Department of Veterans Affairs (VA) medical centers in 2005. It specifically focused on the experiences of these physicians with representatives of the manufacturers of second-generation antipsychotics. VA psychiatrists were invited by e-mail to complete a Web-based questionnaire about their contact with representatives of each of the relevant pharmaceutical companies. Respondents were then questioned about several potential assertions about treatment effectiveness, side effects, and costs of these drugs. Of the 1,833 potential participants, 639 (35%) visited the Web site and completed the questionnaire. Among the responders, 558 (87%) reported at least one contact with company representatives. In the year before the survey the percentage of respondents reporting contact with representatives of each individual company varied from 58% to 70%. The three most commonly reported assertions made at any time in the past through direct speech during those meetings were that the representative's second-generation antipsychotic resulted in "a decreased risk of extrapyramidal symptoms" (79%), "greater symptom reduction than placebo" (78%), or "better negative symptom control than conventional antipsychotics" (77%). Statements least likely to be reported included that drugs resulted in "better positive symptom control than conventional antipsychotics" (36%), "better positive or negative symptom control than another atypical antipsychotic" (38%), and "increased risk of the development of diabetes mellitus" (39%). Comparing assertions reportedly made to VA psychiatrists with package insert information suggests that many assertions made by drug company representatives are inconsistent with prescribing information approved by the U.S. Food and Drug Administration, although assertions consistent with package insert information were more common than inconsistent ones.

User Assessment of Personal Digital Assistants Used in Pharmaceutical Detailing: System Features, Usefulness and Ease of Use

This study explores the perceptions of pharmaceutical sales representatives toward the use of personal digital assistants (PDAs) in pharmaceutical detailing. It uses data from a survey of sales representatives at a large pharmaceutical company that adopted a PDA system for use in pharmaceutical detailing. The study first identifies the specific PDA features that users perceive as being important in performing pharmaceutical detailing tasks. Then, built on the technology acceptance model (TAM), the study examines the important PDA features as antecedents to the perceived usefulness (PU) and perceived ease of use (PEOU) of the system. The results suggest some ways to improve specific system features, which in turn enhance PU and PEOU and through them, system usage. The findings would be useful to those who use or plan to use PDAs for pharmaceutical detailing or other similar mobile tasks.

Unanswered Questions in Schizophrenia Clinical Trials

process is carried out varies enormously from one clinical setting to another and from clinical practice to clinical research. In addition, mental health care is fragmented, and records are often poor or not readily obtainable and as a result gathering an accurate history of previous symptoms, course, treatments utilized, and response (either therapeutic oradverse)canbeverydifficult.Patientsarenotgenerally in a position to provide the desired historical details. It is in this context that clinicians make day-to-day decisions as to how to treat their patients. Clinicians will rely on a number of sources of information in developing a treatment plan but will also be influenced by a variety of other factors. It is difficult to rank order these influences; however, personal training and experience, the influence of current colleagues and ‘‘institutional traditions,’’ pharmaceutical detailing and marketing, lectures and continuing medical education activities, journal articles (ranging from reports of individual trials to reviews and meta-analyses) published guidelines, algorithms or expert consensus reports, cost, access, patient preference, and perceived ‘‘hassles’’ are the most salient. It is with this background that we wish to review the role of the clinical trial in providing appropriate influence in this process. The clinical trial is a mainstay of evidenced-based medicine. In psychiatry, we should be particularly sensitive to the need for appropriate strategies to eliminate, or reduce to the extent possible, subjectivity and bias. It is only after well-controlled studies are conducted that we can draw meaningful conclusions about a treatment’s effects. Though unreplicated trials, uncontrolled systematic descriptions, case reports, etc. can be critical in the process of developing new knowledge, the randomized clinical trial provides the most important evidence and remains the gold standard. It is also true that no single trial, no matter how large, can address themultiplequestionsthatmightberelevantinacomplex disease like schizophrenia. In addition, small trials might have insufficient statistical power to allow firm conclusions, but meta-analysis has become an increasingly valuable (though not without its own pitfalls) strategy to combine results from all available trials to provide further critical knowledge on treatment effects and charac

Public Health Detailing: A Strategy to Improve the Delivery of Clinical Preventive Services in New York City

To promote use of essential clinical preventive services, the New York City Department of Health and Mental Hygiene developed the Public Health Detailing Program, a primary care provider outreach initiative modeled on pharmaceutical detailing. Department representatives conducted topical campaigns, making unscheduled visits to health care practices and meeting with providers and office staff members. Representatives distributed "action kits" containing practice tools, provider information, and patient education materials; nicotine replacement therapy was distributed during the smoking cessation campaign. More than 2,500 interactions with practice staff members were completed by six health department representatives at approximately 200 sites. Physician visits lasted 10 minutes or longer, and by provider self-report, use of office systems for prevention and adherence to recommended practices increased. Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. The effectiveness of this intervention in improving clinical prevention services requires further evaluation.

Understanding physicians’ attitudes towards hormone therapy

We sought to understand the relationship among components of residency education about hormone therapy (HT), knowledge about HT, and provider attitudes toward HT during a time of rapidly changing practice guidelines. We surveyed residents in the University of Pittsburgh Internal Medicine residency programs between February to April 2002 (after the release of the Heart Estrogen/Progestin Replacement Study and prior to the release of preliminary Women's Health Initiative data) regarding demographics, educational (didactic and experiential) exposures to HT and menopause management, knowledge about HT, and attitudes toward HT. Sixty-nine of 92 (75%) eligible residents completed the survey; 38% were women. The race and gender of responders did not differ from nonresponders. Residents had significant didactic exposure to HT and menopause management with 80% reporting more than one didactic exposure. Despite this, HT knowledge was low (mean knowledge score 47 +/- 16%) and only 26% of residents felt prepared to counsel patients about HT. We identified four factors related to provider attitudes toward HT: "persistence" in universally recommending HT, confidence in "HT benefits," concern about "HT cardiac risks," and concern about "HT noncardiac risks." More appropriate attitudes were associated with attending a lecture, having a rotation with a discussion of menopause management (i.e., Women's Health), and a continuity practice including more than 30% women. Pharmaceutical detailing and self-directed study were associated with less appropriate attitudes. Knowledge did not influence attitudes. Strongly held beliefs about the benefits of HT, appropriate or inappropriate, were associated with increasing "persistence." In an area of rapidly changing information, such as the risks and benefits of HT, knowledge is low. Experiential learning appropriately influences attitudes, while pharmaceutical detailing was associated with inappropriate attitudes toward HT risks.

Use of personal digital assistants in pharmaceutical detailing: Perceptions of sales representatives

This study explores the perceptions of pharmaceutical sales representatives toward the use of personal digital assistants (PDAs) in pharmaceutical detailing. It uses data from a survey of sales representatives at a large pharmaceutical company that has adopted a PDA system for use in pharmaceutical detailing. The study identifies the specific features that sales representatives require of the PDA system for pharmaceutical detailing tasks and assesses the capabilities of the PDA system with respect to those features. Given the importance of user perceptions in the process of PDA adoption and implementation, the findings will prove helpful to those who use or plan to use PDAs in pharmaceutical detailing.

Dentists' sources of information about patient medications and other issues of medical management

The frequency of use of sources of information about medications used for patients and other issues of medical management are analyzed in a national sample of general practice dentists (GPs). Subgroups of urban/rural, solo/nonsolo, and younger/middle-aged/older dentists are examined for differences between groups. Assessing mean frequency of use for the entire group, the most frequently used sources of medical information are: 1) the consultant network; 2) the patient's physician; and 3) the Physicians' Desk Reference (PDR). Professional meetings, professional journals, and pharmaceutical detail people are the least frequently used sources. Frequency of use of information sources is related to solo/nonsolo status and to age, but not locale.

The physician and the pharmaceutical detail man: an ethical analysis.

The relationship between the physician and the pharmaceutical detail man is discussed. Specific emphasis is given to an analysis of the ethical implications that this relationship has for patient care.

A simplified formulary for the topical management of pediatric dermatoses.

In the field of pediatrics, as well as in general practice (and even more so in the specialty of dermatology), there is nothing as provoking as the simple rash that will not clear up after one or two office visits with the use of some innocuous local preparations. Certainly, the pharmaceutical detail man—bearer of his company's latest treasures—will acquaint us with the fact that by the discriminate use of his new and miraculous panpharmacons, there should be no trouble in arresting (and even curing) the most recalcitrant dermatoses in very short order. The conscientious, discriminating, and circumspect physician will soon learn, however, that the five-gram tube of the latest fashionable steroid cream—costing upwards of two dollars and useful for, perhaps, two or three applications at most—will seldom, if ever, ameliorate every dermatitis that presents itself in his office. And sooner or later these careful and scrupulous physicians will