Academic medical center detailing policies impact physician prescribing

1. Implementation of detailing policies at academic medical centers led to modest but significant changes in prescribing behavior by physicians at these centers.

Evidence Rating Level: 2 (Good)

Study Rundown: Over the last ten years, increased scrutiny has been placed on the influence that pharmaceutical companies may have on physicians. In particular, whether frequent pharmaceutical sales representative visits or significant gifts play a role in physicians’ decision making has been investigated. As a result, a number of academic medical centers have enacted policies against detailing, or visits from pharmaceutical representatives to their practicing physicians. The purpose of this paper was to determine whether the presence of academic medical center detailing policies led to changes in prescribing. The authors compared changes in prescribing by physicians before and after the implementation of detailing policies at academic centers in 5 states with changes in prescribing by physicians in a matched control group which was not subject to a detailing policy. Between 2006 and 2012, exposure to a detailing policy at an academic center was associated with a decrease in the market share of these detailed drugs and an increase in the market share of nondetailed drugs. These associations were statistically significant for 6 of the 8 drug classes that were investigated and at 9 of 19 academic centers that had implemented these policies.

Overall, this study suggests that detailing policies at academic centers may be effective at modifying prescribing behavior by physicians. However, since the study had an observation design, there may have been other changes that influenced the study results and not simply the implementation of detailing policies. Additionally, the control group physicians were mostly in private practice which could also influence their prescribing behaviors.

Click to read the study, published in JAMA

Relevant Reading: For Sale: Physicians’ prescribing data

In-Depth [retrospective cohort]: This study focused on academic medical centers in 5 states, California, Illinois, Massachusetts, Pennsylvania, and New York. The market share of prescriptions written by physicians for detailed and nondetailed drugs were investigated in 8 drug classes; lipid-lowering, gastroesophageal reflux disease, diabetes, antihypertensive, hypnotic, attention-deficit/hyperactivity disorder, antidepressant, and antipsychotic drugs. The authors compared the 10 to 36 month period before implementation of the detailed policies with the 12 to 36 month period after. A total of 16,121,483 prescriptions were written by 2,126 attending physicians at 19 academic centers and by 24,593 matched control group physicians. The presence of a detailing policy was associated with a decrease in the market share of these detailed drugs by 1.67 percentage points (CI_95% -2.18 to -1.18 percentage points, p < 0.001) and an increase in market share of nondetailed drugs by 0.84 percentage points (CI_95% 0.54 to 1.14 percentage points, p < 0.001). These associations were statistically significant for 6 of the 8 drug classes that were investigated and at 9 of 19 academic centers that had implemented these policies.

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