Healthy Skepticism Library item: 19400
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Mansfield PR
Year of graduation, level of 'scepticism' and attendance at sponsored meetings are significant predictors of General Practioners' beliefs about the appropriateness of drugs
2000;
http://www.healthyskepticism.org/global/news/int/hsin2010-05
Abstract:
Aim: Analysis of the responses from 1,171 General Practitioners to Case study 5 “New Drugs” for variables that predict belief in the appropriateness of drugs. Strategies: Intervention: Case study 5 was part of National Prescribing Service newsletter 7 1999 and was an option towards Practice Incentive Program payments. Respondents were requested to rate appropriateness of therapies. Respondents were also questioned about their position on information from drug companies. Analysis: Quality Use of Medicines scores were constructed from the responses about the appropriateness of 10 drug group options. Depending on their answers to questions about information from drug companies respondents were classified as “Sceptical” or “Accepting”. Outcomes: There were no significant differences between the Quality Use of Medicines scores for General Practitioners with different medical school backgrounds. However, separate analysis of graduates from different medical schools revealed significant interactions with the other predictor variables. Important risk factors for unjustified beliefs about the appropriateness of drugs include in order of significance: • More recent graduation. • Stronger belief that “My prescribing is improved by information from drug companies.” • Belief that a lower % of drug advertisements contain potentially misleading claims. • More frequent attendance at drug company sponsored meetings. In a context where a new drug was not justified “Sceptical” GPs were significantly better at rating it as less appropriate than “Accepting” General Practitioners.
Introduction
Drug promotion is known to be a significant influence on doctors. However there is little information on whether or not it is more important than other influences. Berings et al (1994) studied 128 GPs in Flanders. They found that the number of visits from commercial representatives and the estimated utility of commercial information plus year of graduation accounted for 26% of the variation in the tendency to prescribe benzodiazepines. Caudill et al (1996) studied 446 Kentucky physicians practicing primary care adult medicine. They found that frequency of use of information provided by pharmaceutical representatives and the group practice setting remained significant independent positive predictors of high cost prescribing for 3 case studies in a multivariable regression model. The main purpose of the intervention was educate GPs and perhaps influence prescribing. However the collection of data provided the opportunity to replicate the findings of Berings and Caudill in an Australian setting. In addition this study used a larger sample size and more drug groups.
Methods
The Case Study Case study 5 was part of NPS newsletter 7 1999 and was distributed with the Australian Prescriber. It was promoted as an option towards Practice Incentive Program payments. The case was: You are visited by Mrs Parker an overweight 50 year old woman with mild hypertension and mildly elevated cholesterol levels but no other risk factors. Her only symptoms are insomnia and crying when she thinks her life is worthless now her children have left home. She is also anxious about her sons wedding in six months because she has always felt overwhelmed by big parties. Outcome variables GPs were asked to rate 10 drug and 5 non-drug therapies from 1 = Very inappropriate to 5 = Very appropriate. Only the responses to the drug options will be discussed here. Recommended responses were chosen in collaboration with NPS staff. The recommended diagnoses were: mild hypertension with mildly elevated cardiovascular risk (not high cardiovascular risk), life stage transition distress (not major depression) and normal introversion (not social phobia). The recommended response was to rate one drug group, the Thiazides, as: 5 = Very appropriate but to rate all the other drug groups as: 1 = Very inappropriate. A QUM score was constructed from the sum of the ratings for all 9 other drug options minus the rating for Thiazide. The best possible score was 4 = (9 × 1) – 5 and the worst possible score was 44 = (9 × 5)-1. Potential predictor variables There were 10 potential predictor variables: Five variables came from questions in the case study. GPs were asked the following: • How often do you see drug reps? ___/ month • How often do you attend drug company sponsored meetings? ___/ year • What percentage of drug advertisements contain potentially misleading claims? ___% GPs were asked to circle the answer most likely to be true for: • My prescribing is improved by information from drug companies: • Never Rarely Sometimes Often Always • I can sort the wheat (reliable drug promotion) from the chaff (potentially misleading claims): • Always Often Sometimes Rarely Never Practice size was estimated by counting the number of respondents at the same address. Data for 4 variables were obtained from the Medical Directory of Australia: gender, state where currently working, year of graduation and medical school where graduated. GPs who graduated overseas were grouped by country. A single category was created that included all countries that produced fewer than 10 GPs per country. The data was managed with Access 2000 and analysed with Stata 6.0 software.
