Clinic becomes pharma-free through education, staff input

The removal of pharmaceutical representative visits in a medical clinic resulted in substantially reduced drug costs and increased staff and patient education about the influence of the pharmaceutical industry on practice, according to recent study results published in the Journal of the American Board of Family Medicine.

The analysis explored the steps that a private clinic can take to help quantify the clinic-industry relationship, anticipate clinician and staff concerns, find new ways to provide up-to-date drug information, and educate patients and the public.

Madras Medical Group, a small private practice in rural Oregon, used a practice transformation process that examined the pharmaceutical industry presence in the clinic, educated the doctors on potential conflicts of interest and improved practice flow.

The practice recorded the number of pharmaceutical representative visits. The estimated value of drug samples was compared with generic or lower-cost alternatives. Staff were interviewed and asked to share concerns about clinic operations and policies, as well as their thoughts on the value of seeing pharmaceutical representatives, the usefulness of drug samples and the potential loss of promotional items and personal use of sample medications if the visits were eliminated. Practice staff also learned more about the ethics of the physician-industry relationship and its effect on practice.

These efforts resulted in the consensus adoption and implementation of a pharma-free policy, which went into effect in January 2006, according to researchers. Subsequent inventory of sample medicines showed reduced costs for the less expensive alternatives. The clinic replaced pharma-branded office supplies with supplies purchased at local businesses. To keep clinicians educated on new drugs, non-industry drug information sources were identified and a monthly educational provider meeting was established to discuss both new and old drugs. Patient educational materials describing the transition were also developed and distributed.

“This is a culture change, one that’s already happening but still has a ways to go, especially in smaller private practices,” David Evans, MD, of the department of family medicine at the University of Washington and lead author of the study, stated in a news release. “The relationship between physicians and drug company representatives goes back generations, and it took a methodical deliberate campaign to change it,” said Evans, who was previously a physician at the clinic. “We ultimately decided something had to be done when our medical clinic was visited by drug reps 199 times in 6 months. That number was just staggering.”

For more information:

Evans D. J Am Board Fam Med. 2013;26:332-338.

Disclosures: The researchers reported no relevant financial disclosures.

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