Adapting Pharmaceutical Company Strategies to Improve Physician NSAID Prescribing Behaviors
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications, despite adverse effects that can include gastrointestinal bleed and renal dysfunction. NSAID prescribing rose dramatically from 1999 to 2004, and the increase has been attributed to pharmaceutical companies’ marketing efforts. This study sought to describe the social and communicative strategies that pharmaceutical companies use to influence NSAID prescribing behaviors – and to elicit physicians’ perceptions and counterbalances to these strategies. Investigators conducted interviews with 25 physicians who routinely prescribed NSAIDs; physicians were recruited from a variety of settings, including one VA hospital, and a diversity of medical and surgical specialties. Interview questions focused on the influence of pharmaceutical companies, representatives, drug samples and marketing, as well as physicians’ perceptions of these techniques.
Physicians described several social and communicative strategies used by pharmaceutical companies to influence their NSAID prescribing behaviors, including detailing and direct contact with pharmaceutical representatives, requests from patients inspired by direct-to-consumer advertisements, and marketing during formative medical school and residency training. Practice guidelines and peer-reviewed evidence, as well as local physician experts were viewed as important counterbalances to the influence of pharmaceutical companies. In light of these findings, investigators recommend the following interventions: 1) targeting communicative interactions between trusted physician experts and other local physicians using appropriate detailing of practice guidelines, 2) advertising corresponding messages in public settings within the hospital or clinic that encourage patients to make evidence-informed requests of their physicians, and 3) developing educational and training initiatives for newly hired physicians and clinical trainees.
Naik A, Woofter A, Skinner J, and Abraham N. Pharmaceutical company influence on non-steroidal anti-inflammatory drug prescribing behaviors. The American Journal of Managed Care April 2009;15(4):e9-15.
This study was funded by HSR&D. Dr. Naik is part of HSR&D’s Houston Center for Quality of Care and Utilization Studies; Drs. Woofter and Abraham are with the Michael DeBakey VAMC, Houston.