Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

<h4>Background</h4>Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence...

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Autores principales:	Geoffrey K Spurling, Peter R Mansfield, Brett D Montgomery, Joel Lexchin, Jenny Doust, Noordin Othman, Agnes I Vitry
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/409473a2419044e0a7a3ee3bbc06ea6f
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institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Geoffrey K Spurling Peter R Mansfield Brett D Montgomery Joel Lexchin Jenny Doust Noordin Othman Agnes I Vitry Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
description	<h4>Background</h4>Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.<h4>Methods and findings</h4>We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.<h4>Conclusions</h4>With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.
format	article
author	Geoffrey K Spurling Peter R Mansfield Brett D Montgomery Joel Lexchin Jenny Doust Noordin Othman Agnes I Vitry
author_facet	Geoffrey K Spurling Peter R Mansfield Brett D Montgomery Joel Lexchin Jenny Doust Noordin Othman Agnes I Vitry
author_sort	Geoffrey K Spurling
title	Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
title_short	Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
title_full	Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
title_fullStr	Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
title_full_unstemmed	Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
title_sort	information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/409473a2419044e0a7a3ee3bbc06ea6f
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spelling	oai:doaj.org-article:409473a2419044e0a7a3ee3bbc06ea6f2021-11-18T05:42:02ZInformation from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.1549-12771549-167610.1371/journal.pmed.1000352https://doaj.org/article/409473a2419044e0a7a3ee3bbc06ea6f2010-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20976098/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.<h4>Methods and findings</h4>We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.<h4>Conclusions</h4>With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.Geoffrey K SpurlingPeter R MansfieldBrett D MontgomeryJoel LexchinJenny DoustNoordin OthmanAgnes I VitryPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 7, Iss 10, p e1000352 (2010)

Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

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