Restricting pharmaceutical company representatives from directly promoting their products to doctors reduces prescription of those products, a US study has found.
Some academic medical centres in the United States introduced policies restricting pharmaceutical representatives’ visits to doctors (known as detailing) between 2006 and 2012, and so researchers decided to compare changes in prescribing by doctors before and after implementation of those policies.
The researchers, whose study was funded in part by the US National Institute of Mental Health, looked at 19 centres in five states which brought in policies restricting drug detailing and compared prescribing by 2,126 doctors affiliated with these centres with that of 24,593 matched controls.
The analysis looked at prescribing within eight major drug classes: lipid-lowering drugs, gastroesophageal reflux disease drugs, antidiabetic agents, antihypertensives, sleep aids, attention deficit hyperactivity disorder drugs, antidepressants and antipsychotics. The market shares of promoted drugs within these classes during the 10- to 36-month period before implementation of the detailing policies were compared with those in 12- to 36-month period after implementation,
The results published in JAMA
(online, 2 May 2017) showed that the mean market share of detailed drugs (across all the drug classes) before changes in policy was 19.3%, while that of non-detailed drugs was 14.2%. Over the period of the study, the market share of detailed drugs prescribed by academic medical centre doctors declined by 1.67 percentage points (an 8.7% decrease) while the market share of non-detailed drugs increased by 0.84 percentage points (a 5.6% increase).
The changes were statistically significant overall and for six of the eight individual drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensives, sleep aids, attention-deficit/hyperactivity disorder drugs and antidepressants).
The decline in prescriptions of detailed drugs was greatest at centres with the most stringent policies, such as bans on salespeople in patient care areas, requirements for salesperson registration and training, and penalties for salespeople and physicians for violating the policies.
 Larkin I, Ang D, Steinhart J et al. Association between academic medical center pharmaceutical detailing policies and physician prescribing. JAMA 2017;317(17):1785-1795. doi:10.1001/jama.2017.4039