Backer E L, Lebsack J A, Van Tonder R J, Crabtree B F
Department of Family Medicine, University of Nebraska Medical Center, Omaha 68198-3075, USA.
J Fam Pract. 2000 Sep;49(9):811-6.
Interactions between the pharmaceutical industry and physicians have been discussed in numerous publications; however, most articles are limited to surveys and self-report data and often focus on academic or training contexts. We describe the role of pharmaceutical representatives and the use of samples in community-based family practices, using data obtained by directly observing clinical encounters.
We collected detailed descriptive field notes of the direct observations of 53 primary care clinicians and 1588 patient encounters in 18 purposefully selected Nebraska family practices. We used a comparative case study design, that used depth interviews of clinicians and office staff, and included details of the interactions with pharmaceutical representatives and the use of samples in clinical encounters.
Individual providers and practices displayed noticeable variation in their approaches to drug representatives and samples. We found formal strategies and policies in a minority of practices. Generally there was little structure in the organization and distribution of sample medications at the office level, and detailed patient education regarding these drugs was rarely observed in patient encounters. Nevertheless, samples were used in almost 20% of observed encounters, at times as starter dosages, but often as complete courses of treatment. The benefits derived from contact with the pharmaceutical industry varied substantially, but most often included free medication samples, meals, and patient education materials.
Clinicians have a complex symbiosis with the pharmaceutical industry and need to critically evaluate their handling of samples and their contact with pharmaceutical representatives to optimize this relationship and ensure quality patient care. Clinics with specific policies for interactions with drug companies appear to derive more satisfaction from their encounters.
制药行业与医生之间的互动已在众多出版物中被讨论；然而，大多数文章仅限于调查和自我报告数据，且常常聚焦于学术或培训背景。我们使用通过直接观察临床诊疗过程获得的数据，描述了制药代表在社区家庭医疗实践中的作用以及药品样本的使用情况。
我们收集了对18家特意挑选的内布拉斯加州家庭医疗诊所中53名初级保健临床医生和1588次患者诊疗过程的详细描述性实地记录。我们采用了比较案例研究设计，对临床医生和办公室工作人员进行了深度访谈，内容包括与制药代表互动的细节以及临床诊疗过程中药品样本的使用情况。
个体医疗服务提供者和诊所对待药品代表及样本的方式存在显著差异。我们发现少数诊所有正式的策略和政策。总体而言，办公室层面在样本药物的组织和分发方面几乎没有什么条理，在患者诊疗过程中很少观察到针对这些药物的详细患者教育。尽管如此，在近20%的观察到的诊疗过程中使用了样本，有时作为起始剂量，但通常作为完整疗程。与制药行业接触所带来的益处差异很大，但最常见的包括免费药品样本、餐食和患者教育材料。
临床医生与制药行业存在复杂的共生关系，需要审慎评估他们对样本的处理以及与制药代表的接触，以优化这种关系并确保为患者提供优质护理。对与制药公司互动有特定政策的诊所似乎从这些接触中获得了更多满足感。
