A recent report from Cegedim looked at how pharmaceutical promotion influences physician prescribing behavior. The study looked at four areas:
– Types of pharmaceutical promotional channels
– Promotional channels’ influence on prescription behavior
– Intent to prescribe by Channel for PCPs vs. Specialists; and
– Intent to prescribe for Top 20 most Detailed Drugs in 2010
According to the report, the most commonly used pharmaceutical promotional channels are Detailing, Meetings and Mailings. The report notes that products are often promoted through more than one channel. In addition, sales rep visits are the most popular form of detailing, with 95 percent of contacts being face to face despite the increasing limitations to physician access. Although tele-detailing and e-detailing are emerging forms of detailing, they only account for a small percentage of detailing (2% for both tele-detail and E-detail).
When it comes to meetings as a channel of promotion, the report found that debates with and without dinner, as well as dinner meetings have the highest participation among physicians in 2010. Over 60 percent of physicians participated in these types of meetings. Postal mail was deployed more commonly than emails, with 84 percent of promotional material sent via post in 2010 an only 16% sent via email. With respect to contacts by type:
– 4% conference/symposium
– 4% phone meeting
– 18% other
– 40% Meeting/debate with dinner
– 3% CME
– 9% Debate w/o dinner
– 15% Dinner w/o debate
– 7% E-meeting
The report noted that promotional channels have varying influences on the intent to prescribe. Some promotional channels that were less commonly used showed more effectiveness in influencing physicians’ intent to prescribe products.
When it comes to product detailing, face to face detailing still had the highest influence on the intent to prescribe, with nearly 40 percent of respondents having an increased intent after a sales rep visit. Tele-detailing had the least influence, with intent decreasing to 12 percent in 2010 from 35 percent in 2009. E-detailing increased intent to prescribe approximately 30%.
Although postal mailing is more widely used than emails in promoting products, both resulted in similar levels of intent to prescribe. However, the intent to prescribe has decreased for emails while the intent to prescribe for postal mails have increased in 2010 compared to the previous year.
Meetings have the highest influence on intent to prescribe, with over 40 percent of primary care physicians (PCPs) and specialists intending to increase their prescription following a meeting. Sales visits took second place while mailings had the lowest impact on the prescription behavior of physicians. However, meetings and mailings appear to influence PCPs more than specialists, while detailing was slightly more influential at the specialist level.
% of Physicians who reported an Increased Intent to Prescribe following a Detail, Meeting, or Mailing in 2009-2010.
– Over 50% conference/symposium
– Approx 55% CME
– Approx 40% dinner w/o debate
– Over 35% e-meeting
– Almost 50% debate with dinner
– Over 45% debate w/o dinner
– Almost 50% phone meeting
% of Physicians who reported an Increased Intent to Prescribe following a Detail, Meeting, or Mailing in 2010.
PCPS
- 37% detailing
- 47% meetings
- 29% mailings
Specialists
- 38 % detailing
- 43% meetings
- 27% mailings
Discussion
The most common forms of meetings for promotion of products are dinner debates and dinner meetings. However, these forms of meetings did not have the most influence on intent to prescribe according to the report. The report found that conferences and continuing medical education (CME) had the highest rates of physicians intending to increase their prescription of products, with over 50% of respondents stating increased intent.
However, this number should not be surprising. CME’s intended effect is to educate health care practitioners to change their skills, knowledge and competencies in their respective areas. If changes in prescribing and treatment were not seen after CME programs, there would be a greater cause for concern. CME’s purpose is to educate doctors about new clinical data, treatments, and breakthroughs, and ways to target patients to address chronic diseases, in which there are still gaps in treatment.
Furthermore, any concern that this increase in prescription products leads to greater use of brand name drugs is misguided. Over 75% of drugs prescribed in the U.S. are generics, and almost every state has a law mandating that pharmacies substitute a brand name for generic when available, unless a doctor explicitly recommends the brand name.
Additionally, any attempt to connect commercially supported CME with this increase in prescription products is misplaced. Not only did the data from this report not track what kind of CME programs had this impact (i.e. commercially supported or not), but such evidence would be largely absent. One would have to survey all CME attendees to determine if the commercial nature of the CME program was the primary cause for their increase prescriptions, something almost impossible to measure, especially given there is an extremely low bias rate found in commercially supported CME (i.e. Cleveland Clinic, Medscape, UCSF).
CME is heavily regulated by the Accreditation Council for Continuing Medical Education (ACCME), and adheres to strict standards and guidelines for commercial support. These programs are free from bias, scientifically objective, and closely monitored for any commercial influence. There is no marketing whatsoever, and commercial sponsors have no input in faculty selection or content. As a result, increased prescribing decisions subsequent to attendance at a CME program are based on the valuable scientific information and exchange a physician learns and experiences by attending a CME.
Conclusion
Ultimately, CME stakeholders will soon be entering an era of medical education that focuses on the outcomes of CME programs. CME providers and commercial supporters will be asking, what a particular CME program shows. Does it improve patient outcomes in a particular disease state? Does it improve the skills, knowledge, abilities, and competencies of a particular practitioner? Does CME lead to improved use of guidelines and tools?
The more we begin to see that CME programs increase prescriptions, use of guidelines and tools, and improved outcomes, the more we as CME providers will realize that our programs are creating better outcomes for patients, which will reduce health care costs and close the gaps in treatment in many needed disease areas. Of course, these improvements must be grounded in evidence-based medicine and supported by science, something almost every CME provider strives to do.
Accordingly, increased use of prescription products is simply a way to measure the outcomes of CME programs. Media and the public should realize that accredited CME programs that lead to increased prescriptions do so because of the evidence-based medicine that is taught at such programs, not because of some quid pro quo or biased marketing.
Physicians would not risk their careers and reputations to increase prescribing certain products after a CME program because of marketing. They change their prescribing habits because the CME programs they attend (voluntarily) have high value in the objective scientific information they provide, the valuable exchange of ideas such programs offer, and the unique perspectives the faculty of such programs offer.