Spurling Geoffrey, Mansfield Peter
Discipline of General Practice, University of Queensland, Queensland, Australia.
Qual Saf Health Care. 2007 Aug;16(4):266-70. doi: 10.1136/qshc.2006.020164.
Interaction between pharmaceutical sales representatives (PSRs) and general practitioners (GPs) may have an adverse impact on GP prescribing and therefore may be ethically questionable. This study aimed to evaluate the interactions between PSRs and GPs in an Australian general practice, and develop and evaluate a policy to guide the interaction.
Doctors' prescribing, diaries, practice promotional material and samples were audited and a staff survey undertaken. After receiving feedback, the staff voted on practice policy options. The resulting policy was evaluated 3 and 9 months.
Prior to the intervention, GPs spent on average 40 min/doctor/month with PSRs. There were 239 items of promotional material in the practice and 4660 tablets in the sample cupboard. These were reduced by 32% and 59%, respectively, at 3 months after policy adoption and the reduction was sustained at 9 months. Vioxx was the most common drug name in promotional material. Staff adopted a policy of reduced access to PSRs including: reception staff not to make appointments for PSRs or accept promotional material; PSRs cannot access sample cupboards; GPs wishing to see PSRs may do so outside consulting hours. At 3 and 9 months, most staff were satisfied with the changes. Promotional items/room were not significantly reduced at 3 months (-4.0 items/room ; 95% CI -6.61 to -1.39; p = 0.066) or 9 months (-2.63 items/room; 95% CI -5.86 to 0.60; p = 0.24). Generic prescribing significantly increased at 3 months (OR 2.28, 95% CI 1.31 to 3.86; p = 0.0027) and 9 months (OR 2.07, 95% CI 1.13 to 3.82; p = 0.016).
There was a marked reduction in interactions with PSRs with majority staff satisfaction and improved prescribing practices. The new policy will form part of the practice's orientation package. Reception staff give PSRs a letter explaining the policy. It is hoped that the extra 40 min/doctor of consulting time translates into more time with patients and time to evaluate more independent sources of drug information.
医药销售代表（PSR）与全科医生（GP）之间的互动可能会对全科医生的处方行为产生不利影响，因此在伦理方面可能存在问题。本研究旨在评估澳大利亚一家全科诊所中医药销售代表与全科医生之间的互动情况，并制定和评估一项指导互动的政策。
对医生的处方、日记、诊所宣传资料和样品进行审核，并开展员工调查。在收到反馈后，员工就诊所政策选项进行投票。对最终形成的政策在3个月和9个月时进行评估。
在干预措施实施前，全科医生平均每月与医药销售代表相处40分钟。诊所内有239项宣传资料，样品柜中有4660片药。在政策实施3个月后，这些分别减少了32%和59%，且在9个月时仍保持减少状态。万络是宣传资料中最常见的药品名称。员工采用了减少与医药销售代表接触的政策，包括：前台工作人员不为医药销售代表安排预约或接收宣传资料；医药销售代表无法进入样品柜；希望会见医药销售代表的全科医生可在咨询时间之外进行。在3个月和9个月时，大多数员工对这些变化感到满意。3个月时（-4.0项/房间；95%置信区间-6.61至-1.39；p = 0.066）和9个月时（-2.63项/房间；95%置信区间-5.86至0.60；p = 0.24），宣传物品/房间数量没有显著减少。3个月时（比值比2.28，95%置信区间1.31至3.86；p = 0.0027）和9个月时（比值比2.07，95%置信区间1.13至3.82；p = 0.016），通用名药物处方显著增加。
与医药销售代表的互动显著减少，大多数员工感到满意，处方行为得到改善。新政策将成为诊所入职培训资料的一部分。前台工作人员向医药销售代表提供一封解释该政策的信件。希望每位医生多出的40分钟咨询时间能转化为更多与患者相处的时间以及评估更多独立药物信息来源的时间。
