Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, Australia.
PLoS One. 2021 Mar 18;16(3):e0248238. doi: 10.1371/journal.pone.0248238. eCollection 2021.
Educational activities for physicians sponsored by opioid manufacturers are implicated in the over- and mis-prescribing of opioids. However, the implications of promotion to nurses are poorly understood. Nurses play a key role in assessing pain, addressing the determinants of pain, and administering opioid medications. We sought to understand the nature and content of pain-related educational events sponsored by opioid manufacturers and to compare events targeting physicians and nurses.
We conducted a cross sectional, descriptive analysis of pharmaceutical company reports detailing 116,845 sponsored educational events attended by health professionals from 2011 to 2015 in Australia. We included events that were sponsored by manufacturers of prescription opioid analgesics and were pain related. We compared event characteristics across three attendee groups: (a) physicians only; (b) at least one nurse in attendance; and (c) nurses only. We coded the unstructured data using iteratively generated keywords for variables related to location, format, and content focus.
We identified 3,411 pain-related events sponsored by 3 companies: bioCSL/CSL (n = 15), Janssen (n = 134); and Mundipharma (n = 3,262). Pain-related events were most often multidisciplinary, including at least one nurse (1,964/3,411; 58%); 38% (1,281/3,411) included physicians only, and 5% (166/3,411) nurses only. The majority of events were held in clinical settings (61%) and 43% took the form of a journal club. Chronic pain was the most common event topic (26%) followed by cancer pain and palliative care (18%), and then generic or unspecified references to pain (15%); nearly a third (32%) of event descriptions contained insufficient information to determine the content focus. Nurse-only events were less frequently held in clinical settings (32%; p < .001) and more frequently were product launches (17%; p < .001) and a significantly larger proportion focused on cancer or palliative care (33%; p < .001), generic pain topics (27%; p < .001), and geriatrics (25%; p < .001) than physician-only or multidisciplinary events.
Opioid promotion via sponsored educational events extends beyond physicians to multidisciplinary teams and specifically, nurses. Despite lack of evidence that opioids improve outcomes for long-term chronic non-cancer pain, hundreds of sponsored educational events focused on chronic pain. Regulators should consider the validity of distinguishing between pharmaceutical companies' "promotional" and "non-promotional" activities.
由阿片类药物制造商赞助的针对医生的教育活动与阿片类药物的过度和错误处方有关。然而，针对护士的促销活动的影响却知之甚少。护士在评估疼痛、解决疼痛决定因素和管理阿片类药物方面发挥着关键作用。我们试图了解由阿片类药物制造商赞助的与疼痛相关的教育活动的性质和内容，并比较针对医生和护士的活动。
我们对澳大利亚制药公司报告进行了横断面描述性分析，这些报告详细说明了 2011 年至 2015 年期间有 116845 名卫生专业人员参加的 116845 次由制药公司赞助的教育活动。我们纳入了由处方类阿片类镇痛药制造商赞助且与疼痛相关的活动。我们比较了三个参会者群体（a）仅医生；（b）至少有一名护士参加；和（c）仅护士的活动特征。我们使用迭代生成的关键字对与地点、格式和内容重点相关的变量进行了非结构化数据的编码。
我们确定了 3411 次由 3 家公司赞助的与疼痛相关的活动：bioCSL/CSL（n = 15）；杨森（n = 134）；和 Mundipharma（n = 3262）。与疼痛相关的活动通常是多学科的，包括至少一名护士（1964/3411；58%）；38%（1281/3411）的活动仅包括医生，5%（166/3411）的活动仅包括护士。大多数活动在临床环境中举行（61%），43%的活动采用期刊俱乐部的形式。慢性疼痛是最常见的活动主题（26%），其次是癌症疼痛和姑息治疗（18%），然后是通用或未具体提及疼痛（15%）；近三分之一（32%）的活动描述包含的信息不足以确定内容重点。仅护士参加的活动在临床环境中举行的频率较低（32%；p <.001），更频繁地举办产品发布（17%；p <.001），且更有可能专注于癌症或姑息治疗（33%；p <.001）、通用疼痛主题（27%；p <.001）和老年医学（25%；p <.001），而不是医生或多学科活动。
通过赞助的教育活动进行阿片类药物促销不仅限于医生，还扩展到多学科团队，特别是护士。尽管没有证据表明阿片类药物能改善长期慢性非癌性疼痛的预后，但仍有数百次与慢性疼痛相关的赞助教育活动。监管机构应考虑区分制药公司“促销”和“非促销”活动的有效性。
