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‘Detailing’ policies at academic medical centers lead to fewer prescriptions

Policies limiting visits from pharmaceutical sales representatives, or detailing, led to modest but significant reductions in prescribing behavior, according to research recently published in JAMA.

“No large-scale study has evaluated the association between academic medical center detailing policies and changes in prescribing, despite the large clinical and economic importance of the topic,” Ian Larkin, PhD, of the Anderson School of Management, University of California, Los Angeles, and colleagues wrote.

According to researchers, a policy established by the Pharmaceutical Research and Manufacturers of America in 2002 prohibited all personal gifts except branded items such as paper pads and pens carrying a drug name, company logo, or both, as well as meals given to physicians or staff as part of a sales call. In 2009, branded items were no longer allowed, but the meals could continue.

Larkin and colleagues concentrated their analysis on 19 academic medical centers in California, Illinois, Massachusetts, New York and Pennsylvania. According to researchers, these states have the largest number of academically affiliated physicians, 20.8% of all U.S. academic medical centers and represented nearly 35% of all prescriptions written in the United States. January 2006 to June 2012 was studied because many academic medical centers changed policies during this period. More than 16.1 million prescriptions for antidepressants, antihypertensives , antipsychotics, sleep aids, and medications for attention-deficit/hyperactivity disorder, diabetes, GERD and elevated cholesterol from more than 2,126 attending physicians and 24,593 matched control group physicians were studied. Researchers compared prescribing patterns during the 10- to 36-month period before a detailing policy went into effect vs. the 12- to 36-month period after such a policy’s implementation.

Using a difference-in-differences design, researchers found the average detailed drug had a market share of 19.3%; the average nondetailed drug’s market share was 14.2%. Policy enactment was associated with a decrease in the market share of detailed drugs of 1.67 percentage points (95% CI, –2.18 to –1.18) and an increase in the market share of nondetailed drugs of 0.84 percentage points (95% CI, 0.54-1.14). Associations were statistically significant for all but the diabetes and antipsychotic drug classes.

“[This] study provides new evidence relevant to the evaluation of detailing policies by examining changes in the prescribing of detailed and nondetailed drugs by physicianswho were and were not subject to detailing policies implemented at academic medical centers,” Larkin and colleagues wrote. “In 2010, pharmaceutical companies earned more than $60 billion in revenues for detailed drugs included in the study. ... A [one]-percentage point change in market share could represent approximately a 5% relative change in revenue for the average detailed drug, suggesting that the observed changes in prescribing could have important economic implications.”

In a related editorial, Colette DeJong, BA, and R. Adams Dudley, MD, MBA, of the Center for Healthcare Value, University of California, San Francisco, wrote that detailing comes with the benefit of potentially saving patients money, but it also comes with potential risks for physicians not knowing as much about the medications they are prescribing. These researchers suggested reforming payment models, and creating alternative payment models and alternative approaches to drug education that avoids conflicts of interest and reforming payment models as “feasible alternatives” to detailing.

“It has never been more important for physicians to come together to consider these alternatives, generate evidence about their effectiveness, and move the health care system toward solutions that lower costs for patients and minimize [conflicts of interests],” DeJong and Dudley wrote. – by Janel Miller

Disclosure: DeJong, Dudley and Larkin report no relevant financial disclosures. Please see the study for a full list of the other authors’ relevant financial disclosures.