Pharmaceutical Representatives Research Articles

PO009 Prediction of Atrial Fibrillation Recurrence After Catheter Ablation, By Interatrial Conduction Time Assessed With Tissue Doppler Imaging

Health-system barriers and facilitators associated with cardiovascular medication adherence have seldom been studied, particularly in low- and middle-income countries where uptake rates are poorest.This study sought to explore the major obstacles and facilitators to the use of evidence-supported medications for secondary prevention of cardiovascular disease using qualitative analysis in 2 diverse countries across multiple levels of their health care systems.A qualitative descriptive study approach was implemented in Hamilton, Ontario, Canada, and Delhi, India. A purposeful sample (n = 69) of 23 patients, 10 physicians, 2 nurse practitioners, 5 Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy physicians, 11 pharmacists, 3 nurses, 4 hospital administrators, 1 social worker, 3 nongovernmental organization workers, 2 pharmaceutical company representatives, and 5 policy makers participated in interviews in Hamilton, Ontario, Canada (n = 21), and Delhi, India (n = 48). All interviews were digitally recorded and transcribed followed by directed content analysis to summarize and categorize the interviews.Themes that emerged across the stakeholder groups included: medication counseling; monitoring adherence; medication availability; medication affordability and drug coverage; time restrictions; and task shifting. The depth of verbal medication counseling provided varied substantially between countries, with prescribers in India unable to convey relevant information about drug treatments due to time constraint and high patient load. Canadian patients reported drug affordability as a common issue and very few patients were familiar with government subsidized drug programs. In India, patients purchased medications out-of-pocket from private, community pharmacies to avoid long commutes, lost wages, and unavailability of medications from hospitals formularies. Task shifting medication-refilling and titration to nonphysician health workers was accepted and supported by physicians in Canada but not in India, where many of the physicians considered a high level of clinical expertise a precondition to carry out these tasks skillfully.Our findings reveal context-specific, health system factors that affect the patient's choice or ability to initiate and/or continue cardiovascular medication. Strategies to optimize cardiovascular drug use should be targeted and relevant to the health care system.

How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria.

Limited access to essential medicines for maternal and child health is a preventable cause of pregnancy-related deaths. This remains a predominant challenge in Nigeria, where sub-standard and falsified medications have historically been associated with maternal mortality. An in-depth understanding of perceptions surrounding quality assurance of essential medicines is pertinent for developing effective and sustainable interventions. To examine stakeholder perspectives on quality control of essential medicines for maternal and child health, while characterizing pharmaceutical distribution of medicines in Nigeria. Key informant interviews were conducted with a purposive sample of 26 participants between January and June 2018. Eligible participants included: pharmacists, pharmaceutical sales representatives (pharm reps), supply chain employees of pharmaceutical industries and regulatory agency personnel, working in the public or private health sector in either of the four states: Lagos, Enugu, Imo or Port-Harcourt. A 6-item survey was administered to collect demographic information on the participants. This was followed by 15 semi-structured questions to gather qualitative data on the subject matter. Verifying vendor credibility and use of identifiable regulatory markers were the most common methods adopted by pharmacists and pharm reps with the intent to control quality of medicines. Key challenges in assuring quality included: inefficiency of regulatory agencies, illicit sales of prescription medicines by patent medicine vendors, existence of open markets and failed policy implementation. While pharmacists and pharm reps solicited improved regulations and policy implementation; NAFDAC personnel primarily recommended an increased government funding to improve their efficiency. Beyond stakeholder recommendations, a fervent and consistent commitment on the part of the government is needed to improve quality assurance in Nigeria's pharmaceutical system. Public-private partnerships should be explored to address funding limitations to quality assurance. Future studies need to examine challenges and opportunities surrounding policy implementation, and regulatory enforcement in pharmaceutical distribution.

Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis-Knowledge Gaps and Research Opportunities: Overview Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop.

A workshop was sponsored by the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, on July 25, 2018, in Pittsburgh, Penn. The workshop was designed to bring together a multidisciplinary group of experts to accelerate the development of therapeutics for clinical application in inflammatory diseases of the exocrine pancreas. Three separate working groups (acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis) were formed to address the needs, gaps, and opportunities. The working groups included patients with pancreatic diseases, pharmaceutical company leaders, basic scientists, clinical researchers, and representatives from the US Food and Drug Administration to assist with regulatory considerations and to identify the unmet needs, research targets, and opportunities to provide direction for successful development of therapeutic agents in these diseases. This article represents the summary of the overview presentations at the National Institute of Diabetes and Digestive and Kidney Diseases workshop including an ongoing drug trial in acute pancreatitis; a successful drug development network developed by the Cystic Fibrosis Foundation; and considerations for subject selection in drug trials, incorporating Food and Drug Administration guidelines on clinical trial design and clinical outcome measures. The summaries of each working group follow separately in accompanying articles.

From science to real-life oncology-the ECCO 2018 European Cancer Summit, 7-9 September 2018, Vienna, Austria.

The European CanCer Organisation (ECCO) held its first European Cancer Summit in Vienna, Austria, from 7–9 September 2018. The summit, ‘From Science to Real-life Oncology’, attracted over 370 participants from across the globe. The aim of the event was connecting science with real life through policy evolution. A broad range of stakeholders attended the event including representatives of ECCO Member Societies, healthcare professionals, pharmaceutical company representatives, patient organisations including patient advocates, commercial providers to the healthcare sector, EU and national/regional government officials as well as academic researchers and regulatory professionals. The summit provided the opportunity to discuss some challenging issues including a European agenda on cancer, the use of big data and putting a price on cancer medicines. One of the objectives of the summit was to gather stakeholder decisions on resolutions looking at efficiency in cancer care, integration of services and quality. The result was a highly interactive well-attended meeting which permitted networking opportunities across stakeholder groups and giving direction to European cancer care.

PHP205 - BARRIERS TO AND FACILITATORS OF THE APPLICATION OF HEALTH TECHNOLOGY ASSESSMENT IN MEDICINE PRICING AND REIMBURSEMENT POLICIES IN INDONESIA

Objectives: This study aimed to identify the barriers and facilitators of the utilization of health technology assessment (HTA), a process which is infrequently applied to the selection of medicines listed in the medicine pricing and reimbursement policies in Indonesia. Methods: Semi-structured interviews were conducted to collect qualitative data. Purposive sampling was used to recruit the stakeholders, which consisted of policymakers, a pharmaceutical industry representative, healthcare providers, and patients. The data were analyzed using directed content analysis to systematically organize the data into a structured format. A COnsolidated criteria for REporting Qualitative studies (COREQ) checklist was followed to ensure a high quality and comprehensive report of the findings. Results: The twenty-five participants interviewed provided a range of barriers and promoting factors for the implementation of HTA in Indonesia. A lack of capability of local human resources, a lack of incentives, unintegrated data, as well as a lack of a clear framework were mentioned as barriers. An important promoting factor was seen in the Indonesian law which stipulated that HTA was mandatory for selecting medicines listed in the medicine pricing and reimbursement policies. Strategies suggested to overcome the barriers include setting up an HTA department in several Indonesian universities, introducing a clear framework for the implementation of HTA in the guidelines, and establishing relationships with other countries with a well-developed HTA or with HTA associations. Conclusions: Several barriers are currently preventing the implementation of HTA in medicine pricing and reimbursement policy in Indonesia, however, solutions to these issues exist.

PHP271 - THE GROWING IMPORTANCE OF DIGITAL CHANNELS IN FORMULARY DECISION MAKING IN THE US

The aim of the study was to understand how US payers obtain information, specifically using digital methods, for decision making in addition to face-to-face interaction with pharmaceutical companies. An online survey was conducted in August/September 2017 in the US. Respondents needed to be voting members, advisors or pharmacists contributing to a pharmacy and therapeutic (P&T) committee in their organization. In total, 189 P&T committee members were surveyed; 62 in hospitals, 45 in integrated delivery networks (IDNs) without health plans, 26 in IDNs with health plans, 41 in managed care organizations, and 15 in pharmacy benefit management. The majority (85%) of payers surveyed agreed that digital resources are essential to the process of making formulary decisions. Search engines and websites for healthcare professionals (HCPs) informed payers’ committee work more frequently than any other source, with 63% using HCP websites weekly to access professional information. In lieu of resource availability, online live webcasts with experts (64% of payers) and on-demand online presentations about prescription drugs (60%) have overtaken face-to-face conversations with pharmaceutical company representatives (59%) as a factor influencing formulary decisions. A total of 75% of payers stated that partnerships with pharmaceutical companies to develop patient support solutions may influence formulary placement if improvements in outcomes are demonstrated. In particular, payers were interested in working with pharmaceutical companies on patient-centered digital tools to reduce readmissions (74%), improve adherence (66%), address disease management (56%), improve care coordination (56%), perform patient self-tracking (50%), promote general health and wellness (50%), and enable remote monitoring (48%). This study shows that payers in the US rely heavily on digital sources for formulary decisions, and are open to partnering with pharmaceutical companies to develop digital patient support solutions to optimize outcomes. Further work in this area is planned among EU and other global payers.

Impact of a dedicated medication access coordinator on PCSK9 inhibitor approval rates

Background: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors significantly reduce the risk of major adverse cardiovascular events in high risk patients. The most significant barrier with these drugs is cost (estimated average wholesale price [AWP] $14K per year). For these drugs to be cost-effective, their cost needs to be ∼1/3 of their current AWP. The use of these drugs requires payer approval with substantial provider and clinic staff resources needed to gain prior authorization (PA).Objectives: To justify the utilization of a disease-state pharmacy medication expert in the cardiology clinic to assist with benefit investigation and prior authorization efforts for this class of medication to optimize prescription approval rates.Methods: A pharmacy technician from the integrated delivery network (IDN) who received training in the role of medication access coordinator (MAC) was placed in the outpatient cardiology clinic late in 2017. The MAC worked with clinic providers, specialty pharmacy, payers, and pharmaceutical company representatives to streamline the traditional methods of benefit investigation and the PA process.Results: From December 2017 to April 2018, the MAC reviewed and assisted with PCSK9 inhibitor PA in 325 cardiac patients. Of the 325 patients, 48 were pending PA, currently denied, or pending medication trial. PA approval in the remaining patients were: 8 with Medicaid ($0 copay); 88 with commercial insurance (≤$10 monthly copay); 80 with Medicare and Amgen Safety Net foundation ($0 copay); 15 pending for the Medicare/pharmaceutical manufacturer foundation; 8 with low income subsidy (LIS) (≤$8.35/90 day copay); 6 with Medicare and alirocumab (Praluent®) Assistance (PASS $0 copay) with 4 others pending approval; and 1 with the Pan Foundation. The remaining 67 had Medicare coverage and an adjusted gross income >$83,000/year. These patients opted not to receive treatment due to cost. As an indicator of the success of the MAC initiative, the success rate of evolocumab (Repatha®) approvals for the IDN across the country is 82%. This is compared to 62% regionally and 60% nationally for non-IDN patients. This shows the impact of the implementation and approval success of the MAC role.Conclusions: There is clear benefit of the MAC in the cardiology clinics of the IDN. PA rates with these drugs are among the most challenging of all specialty drugs. By channeling benefit investigation and PA through the MAC, PA approval was increased by 20%. Similar approaches using a MAC in other disease states should improve specialty pharmacy medication approvals.

The gold-standard in preclinical abuse liability testing: It's all relative

All new molecular entities (NMEs) with targeted or indirect effects on the central nervous system (CNS) must be evaluated for their abuse liability as a part of their nonclinical development plan. Inherently key in the drug control review is the term “relative abuse liability”. The basis for determination of drug control is critically dependent on the nonclinical assessment of the reinforcing attributes of the NME in animals (rat is the regulatory preferred species) in a standard operant conditioning paradigm. Pharmaceutical representatives without a background in behavioral analysis or operant conditioning models must weigh through conceptually-intriguing language and constructs that accurately convey and communicate the relative potential for abuse to drug regulatory experts in the field. Effective statutory language in the preclinical assessment of relative abuse liabilities for schedule control status reviews must be 1) specific; 2) concise; 3) familiar to the regulators; 4) unambiguous; 5) constructive; and 6) formalized with respect to both international and national drug control policies. In this review we attempt to define and highlight the importance of the statutory language used to report self-administration study results to both parties engaged in NDA approval process.

Discrepancies Between US Food and Drug Administration Vaccine Licensure Indications and Advisory Committee on Immunization Practices Recommendations: Provider Knowledge and Attitudes

PurposeIn the United States, the Center for Biologics Evaluation and Research at the US Food and Drug Administration (FDA) is responsible for licensure of vaccines. The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that provides guidance to the Centers for Disease Control and Prevention (CDC) on use of vaccines. Discrepancies between FDA licensure indications and ACIP/CDC vaccine recommendations exist, challenging health care providers. The objectives of this study were: (1) to categorize differences between FDA vaccine licensure indications and ACIP/CDC vaccine recommendations for vaccines; and (2) to assess knowledge, attitudes, and practices of pediatricians, family physicians, and obstetrician-gynecologists regarding their understanding of differences. MethodsInformation was extracted from FDAvaccine package inserts, and corresponding information was collected for ACIP/CDC vaccine recommendations (2000–2014) for vaccines in the childhood and adult immunization schedules. Surveys regarding knowledge of discrepancies were distributed electronically to members of the Georgia chapters of the American Academy of Pediatrics (GA-AAP) and the American Academy of Family Physicians (GA-AAFP), and the national American College of Obstetricians and Gynecologists (ACOG) in 2014. FindingsDifferences were identified in 20 instances: differences in age group indications were identified in 6, in dosing administration schedules in 4, and in immunocompromised hosts and pregnant women in 10. We received 145 (8.5%) responses from GA-AAP, 237 (9.5%) from GA-AAFP, and 869 (1.5%) from national ACOG members. A total of 105 (72%) GA-AAP respondents reported that they follow AAP recommendations and 168 (71%) GA-AAFP respondents follow ACIP recommendations. GA-AAP and GA-AAFP respondents generally were not aware of data the FDA considers for vaccine licensure or data that pharmaceutical company representatives are permitted to discuss. Respondents remain current with vaccine recommendations through review of materials from professional organizations, the CDC, and package inserts; Continuing Medical Education; and information from pharmaceutical representatives. A total of 780 (90%) ACOG respondents had no concerns regarding routinely recommended reduced diphtheria toxoid and acellular pertussis vaccines (n = 730 [84%]) and influenza during pregnancy vaccines (n = 852 [98%]) to pregnant patients. However, these findings must be interpreted within the context of a low overall ACOG survey response rate. ImplicationsEducation regarding existence of and reasons for discrepancies between FDA licensure of and ACIP/CDC recommendations for vaccines and reasons for these differences could optimize immunization delivery.

Terrorism vulnerability: organizations’ ambiguous expectations and employees’ conflicting priorities

This study demonstrates how field employees’ perceived threat of terrorism (PTT) is magnified by the incompatibility between role demand (travel and work outdoors) and resources (terrorism-endangered environment). With a foundation in the conservation of resources perspective and transactional theory of stress, a theoretical framework was proposed to test the mediating effect of role ambiguity (RA) and role conflict (RC) in the relationship between PTT and emotional exhaustion (EE). An approach involving confirmatory factor analysis and the structural equation was used for analysis. Data from 432 pharmaceutical sales representatives indicate a significant positive relationship between PTT and EE, while RA and RC significantly mediated the relationship. The findings are potentially useful for employers in charge of field employees in high-risk regions by explaining how such groups can be provided with support to reduce their role stress and exhaustion, leading ultimately to increased satisfaction.

Bayesian structural equation modelling tutorial for novice management researchers

PurposeThis paper aims to popularize the Bayesian methods among novice management researchers. The paper interprets the results of Bayesian method of confirmatory factor analysis (CFA), structural equation modelling (SEM), mediation and moderation analysis, with the intention that the novice researchers will apply this method in their research. The paper made an attempt in discussing various complex mathematical concepts such as Markov Chain Monte Carlo, Bayes factor, Bayesian information criterion and deviance information criterion (DIC), etc. in a lucid manner.Design/methodology/approachData collected from 172 pharmaceutical sales representatives were used. The study will help the management researchers to perform Bayesian CFA, Bayesian SEM, Bayesian moderation analysis and Bayesian mediation analysis using SPSS AMOS software.FindingsThe interpretation of the results of Bayesian CFA, Bayesian SEM and Bayesian mediation analysis were discussed.Practical implicationsThe management scholars are non-statisticians and are not much aware of the benefits offered by Bayesian methods. Hitherto, the management scholars use predominantly traditional SEM in validating their models empirically, and this study will give an exposure to “Bayesian statistics” that has practical advantages.Originality/valueThis is one paper, which discusses the following four concepts: Bayesian method of CFA, SEM, mediation and moderation analysis.

Practical aspects of innovative communication technologies use in the work of medical (pharmaceutical) representatives and the ways of their enhancement

Aim. To substantiate the applied conditions and to develop the practical recommendations on the adaptation of modern innovative communication technologies, the ways of their improvement in the work of medical (pharmaceutical) representatives aimed at ensuring the effectiveness of their professional activities as the main representatives of personalized integration of pharmacy and business. Results. The article analyzes software products used in practice of medical (pharmaceutical) representatives. The functionality of modern software is definitely constantly increasing. The innovative changes in the marketing communication activities of medical (pharmaceutical) representatives under the influence of the development of information and communication technologies are demonstrated. Systematization of individual CRM-systems platforms, adapted to the work of medical (pharmaceutical) representatives and designed to manage all types of sales was carried out: from short orders to long-term corporate transactions, their practical application possibilities were viewed. The main tasks and tools of the automatic control system Absalon CRM are detailed. A sociological investigation was carried out, the results indicated an insufficient level of innovative communication introduction technologies in the marketing communication activities of medical (pharmaceutical) representatives. Conclusions. The introduction of modern innovative communication technologies in the activities of medical (pharmaceutical) representatives needs special financial support with the prospect of investment return and constant monitoring by the pharmaceutical companies and with the participation of practitioners and scientists in order to search for new electronic and software products, ascertaining them as innovative products of business-communicative technologies.

Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership.

Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to adopting, implementing, and sustaining pharmacotherapy can be overcome through incremental testing of organizational change strategies, accompanied by expert coaching and a learning community of like-minded professionals. The greatest challenges lie in overcoming abstinence-only philosophies, establishing a business case for pharmacotherapy, and working with payers and pharmaceutical representatives.

Evaluation of drug promotional brochures in a tertiary teaching hospital of Kannur, India

Background: Pharmaceutical industries worldwide are heavily involved in aggressive drug promotions. WHO has framed guidelines for ethical drug promotion in 1988. The transparency of pharmaceutical advertisements is important because decision of the physician is likely to be influenced by the claims made by the pharmaceutical companies in the promotional drug brochures and pharmaceutical industries treat their marketing material as “educational material” for doctors. Authors did this study to analyze the information given on drug promotional brochures by the drug companies using ethical criteria of drug promotion by WHO 1988 and to verify the authenticity of the claims given by the pharmaceutical companies in drug promotional brochures.Methods: Cross sectional study extending from 1/8/2012 to 31/7/2013. 612 drug promotional brochures satisfied our inclusion criteria. Drug brochures were analyzed with WHO ethical criteria 1988 and further categorizing the data into type of claims, number and source of references. Validity of journal articles were checked by using a validity measure developed by Cardarelli.Results: Total 612 brochures satisfied inclusion criteria. INN was mentioned in 93.8% of collected brochures. Brand name was mentioned in 100% brochures. Content of active ingredients was mentioned in 92% of brochures. Name of the other ingredients known to cause problem 28.4% of brochures. Dosage form or regimen was mentioned in 23.2% of brochures. Approved therapeutic use mentioned in 65.7% brochures. Side effects and major adverse drug reactions were mentioned in 31.4% brochures. Precautions and contraindications and warnings were mentioned in 30.4% drug promotional brochures. Drug interactions were mentioned in 26.5% brochures. Name and address was mentioned by 69.1% brochures. There were 1144 claims and 739 references. Efficacy claims were 84.88% of the total claims. Main source of reference was from journal articles (74.1%) and among them 49.65% were randomized control trials. Only 47.94 % of the journal references were valid.Conclusions: Brochures were lacking in vital information which included contraindication, warning, precaution, name of the other ingredients known to cause problem hence companies were found violating WHO ethical criteria. Claims were not well supported with references. Less than half of the given journal references were only valid. This study highlights the need of healthcare professionals to remain cautious about promotional material presented by pharmaceutical representatives.

Determinants of antibiotic prescribing among doctors in a Nigerian urban tertiary hospital

ABSTRACTObjectives: The problem of antimicrobial resistance (AMR) has assumed pandemic dimensions especially among low-and middle-income countries such as Nigeria. Irrational use of currently available antimicrobial agents is a major contributory factor. There remains a paucity of documented information on the determinants of antibiotic prescribing among physicians in Nigeria to guide future strategies to reduce AMR. This study therefore aimed to investigate the patterns and determinants of antibiotic prescribing among doctors in a tertiary hospital in Nigeria as the first step to improve future antibiotic use in hospitals.Methods: A cross-sectional survey of the determinants of antibiotic prescribing among doctors in the Lagos State University Teaching Hospital, Ikeja, was performed using a structured questionnaire. Information was obtained about the doctors and the factors determining their prescription of antibiotics. The results were summarized using descriptive statistics with Statistical Package for Social Science.Results: Ninety-eight respondents were studied with a mean age of 36.24(9.01) years, a mean duration of practice of 10.68(9.25) years, and mainly males (64.3%). Ninety-seven percent prescribe antibiotics frequently, mostly based on clinical judgment and experience with rare laboratory supports. Factors of cost, drug availability, and information from pharmaceutical representatives influenced antibiotic prescribing. There were indications of nonexistence or nonfunctional institutional policies and guidelines regarding antimicrobial therapies.Conclusion: There is an urgent need to institute evidence-based institutional policies and guidelines for improving antimicrobial use among hospitals in Nigeria. This is already being followed up.

Exploring the Barriers to and Facilitators of Using Evidence-Based Drugs in the Secondary Prevention of Cardiovascular Diseases: Findings From a Multistakeholder, Qualitative Analysis

Health-system barriers and facilitators associated with cardiovascular medication adherence have seldom been studied, particularly in low- and middle-income countries where uptake rates are poorest. This study sought to explore the major obstacles and facilitators to the use of evidence-supported medications for secondary prevention of cardiovascular disease using qualitative analysis in 2 diverse countries across multiple levels of their health care systems. A qualitative descriptive study approach was implemented in Hamilton, Ontario, Canada, and Delhi, India. A purposeful sample (n= 69) of 23 patients, 10 physicians, 2 nurse practitioners, 5 Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy physicians, 11 pharmacists, 3 nurses, 4 hospital administrators, 1 social worker, 3 nongovernmental organization workers, 2 pharmaceutical company representatives, and 5 policy makers participated in interviews in Hamilton, Ontario, Canada (n= 21), and Delhi, India (n= 48). All interviews were digitally recorded and transcribed followed by directed content analysis to summarize and categorize the interviews. Themes that emerged across the stakeholder groups included: medication counseling; monitoring adherence; medication availability; medication affordability and drug coverage; time restrictions; and task shifting. The depth of verbal medication counseling provided varied substantially between countries, with prescribers in India unable to convey relevant information about drug treatments due to time constraint and high patient load. Canadian patients reported drug affordability as a common issue and very few patients were familiar with government subsidized drug programs. In India, patients purchased medications out-of-pocket from private, community pharmacies to avoid long commutes, lost wages, and unavailability of medications from hospitals formularies. Task shifting medication-refilling and titration to nonphysician health workers was accepted and supported by physicians in Canada but not in India, where many of the physicians considered a high level of clinical expertise a precondition to carry out these tasks skillfully. Our findings reveal context-specific, health system factors that affect the patient's choice or ability to initiate and/or continue cardiovascular medication. Strategies to optimize cardiovascular drug use should be targeted and relevant to the health care system.

Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications

ABSTRACTObjective: Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits.Methods: Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria.Results: 176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients’ clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry.Conclusion: Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.

Reconciling a “pleasant exchange” with evidence of information bias: A three-country study on pharmaceutical sales visits in primary care

ObjectivesTo examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. MethodsWe recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach. ResultsFifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions. ConclusionsPhysicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs’ safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.

Impact of Job Stress on Job Satisfaction among the Pharmaceutical Sales Representatives

The prime objective of this study is to identify the relationship between job stress and job satisfaction among the pharmaceutical sales representatives. The primary data for this study was compiled through well-structured questionnaire filled in on a one-to-one basis by 200 pharmaceutical sales representatives. The determinants of job stress that have been idenfitied under this study includes job nature, work relationships, roles and responsibilities, lack of career development, and organizational structure and climate. The study results clearly indicated that the majority of the pharmaceutical sales representatives are facing high level of job stress and they are in the high level of job dissatisfaction. The result also reveals that there is a significant negative relationship between job stress and job satisfaction.

Visits by pharmaceutical representatives in general practice as observed by fifth-year medical students.

Many general practitioners receive visits at their surgery from pharmaceutical representatives. The purpose of this study was to describe these visits, their framework and content (especially discussions of safety information), and to compare the findings with a corresponding study conducted in 2001–02. A total of 116 fifth-year medical students (2001–02: 144) at the University of Oslo in practical training at GP surgeries in the South-Eastern Norway Regional Health Authority in the period 2014–16 completed an electronic questionnaire after attending a visit by a pharmaceutical representative at the medical centre. A total of 116 visits took place during lunch breaks, when the representative paid for the food. In 90 % (2001–02: 81 %) of the visits, both doctors and their colleagues attended. Free samples were given out in 28 % (2001–02: 41 %) of the meetings, and small gifts in 5 % (2001–02: 44 %). Although the representative often refrained from raising the topic of safety information about the medication, this nevertheless happened less often than in 2001–02: adverse effects (42 % vs 55 %; p=0.04), interactions (53 % vs 64 %; p=0.07), contraindications (37 % vs 61 %; p= 0.0002) and precautions (30 % vs 56 %; p<0.0001). The medical students gave a below average score for their own learning outcome from the presentations (4.8 on a scale from 0–10) (2001–02: 4.2). Although the study shows improvements since 2001–02, it is still common for information provided at visits by pharmaceutical representatives to be deficient with regard to discussion of adverse effects, interactions, contraindications and precautions. Doctors must base their judgement on independent sources of information in order to stay abreast of the latest safety data on the medications.