Cost-ineffective drug prescribing practices revealed

By Piriya Mahendra, medwireNews Reporter

Around four in 10 physicians prescribe a brand-name drug due to a patient request, when a generic equivalent is available, find researchers.

This practice incurs substantial cost to the healthcare system and is unnecessary, report Eric Campbell (Massachusetts General Hospital, Boston, USA) and colleagues in JAMA Internal Medicine (formerly Archives of Internal Medicine).

Findings from a national questionnaire administered to 1891 physicians in the USA revealed that 43% of those who have been practicing for over 30 years sometimes or often administer brand-name drugs due to patient request compared with 31% of physicians practicing for 10 years or less.

Physicians working primarily in solo or two-person practices were significantly more likely to acquiesce to patient demands than those working in a hospital or medical-school setting, at 46% versus 35%.

Among the various specialties included in the survey, pediatricians, anesthesiologists, cardiologists, and general surgeons were significantly less likely to acquiesce to patient demands than were internal medicine physicians, at 17%, 26%, 44%, and 20% versus 50%, respectively.

Physicians who received free food or beverages from industry in the workplace were more likely to honor patient requests than those who did not receive gifts, at 39% versus 33%. Moreover, physicians who received drug samples from industry were also significantly more likely to honor patient requests than those who did not receive samples, at 40% versus 31%.

In addition, clinicians who met with industry representatives to stay up to date with drug information were significantly more likely to comply with patients' demands for brand-name drugs, at 40% versus 34% of those who did not have these meetings.

"These findings are likely the result of the fact that industry gifting of food and beverages coincides with 'up-to-date meetings' with drug representatives, thus, these factors work together to increase the likelihood that physicians will prescribe a brand name and clearly serve a marketing function," write Campbell et al.

They say that having a closed health system such as the Veterans Health Administration or that used in the UK would give the pharmacy primary control over brand-name or generic drug-prescribing decisions, with override capability for rare situations when it is necessary.

Also, hospitals and health systems could consider policies that prevent individual physicians from receiving samples and instead require samples be given to a pharmacy or another appropriate office in a hospital or health system, they say.

"Finally, payers such as Medicare or commercial insurers who are interested in increasing the use of generic drugs may consider banning physicians from accepting food and beverages in the workplaces," suggest the authors.

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