Healthy Skepticism Library item: 19848

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Publication type: Journal Article

Sigmon JL, Anastasio GD
Drug Sample Closet
Journal of Family Practice 1992; 34:(3):262-3

Abstract:

To The Editor:
Ten years ago our family practice department created a system to clean up our chaotic drug sample closet. The focal point of our system is a Pharmacy and Patient Education (PPE) Committee.

The committee serves two main purposes. First, it established an interdisciplinary group to decide which drugs to include in the sample closet. Second, it serves as a model of the hospital and practice committees on which our residents will be involved. The PPE Committee includes in the drug closet only samples that address the most common needs of patients treated in the practice. This promotes efficient use of our limited office storage space and cultivates rational prescribing habits in our residents.

The committee consists of the clinic director, the clinical pharmacist, the head nurse, and three residents who rotate onto the committee in second or third year. The committee meets quarterly to consider changes in the sample formulary. Requests for adding a new drug may be submitted by any faculty member, resident, staff nurse, or pharmaceutical representative.

Before a committee meeting, one of the resident members reviews pharmaceutical company literature and independent scientific research about the proposed drug. The resident must find out the cost, efficacy, and side effects of the drug. The drug is also compared with any similar drug agent currently on the formulary. If the drug is in a new therapeutic class, the resident must determine a rationale for adding the drug to the formulary. At the meeting, the resident presents a summary of the literature for committee members to deliberate.

Only drugs approved by the committee are stocked in the sample closet. Periodically, drugs that are infrequently used, or that have been replaced by superior agents, are removed from the formulary. Only approved samples stocked in the closet is limited to the volume customarily distributed to patients in our practice. When a company stops offering a drug in sample form, it is withdrawn from the formulary.

Under the direction of the pharmacist, the committee strives to: (1) stock one or two of the least expensive drugs in each therapeutic class; (2) delay adding new agents until all of their adverse reactions and drug interactions are clinically demonstrated; (3) refrain from adding “me too” drugs unless they have clear advantages; and (4) accept drugs that have generic equivalents offering long-term savings to patients.

Some drugs are not available in the sample closet. Commonly used, inexpensive antibiotics, such as penicillin, are not available because pharmaceutical companies usually distribute samples of new, patented and relatively expensive drugs. Psychoactive drugs and drugs with abuse potential are excluded from our formulary for obvious reasons.

A nurse orders, stocks, labels, and discards samples from the closet under the supervision of a pharmacist. Our physicians dispense samples as specified by state law. Pharmaceutical representatives are not allowed in the sample closet. Each pharmaceutical representative is given a copy of the committee guidelines and the clinics formulary policies.

In summary, the Pharmacy and Patient Education Committee teaches residents how to: (1) systematically evaluate drugs to include in a sample closet, (2) participate in an interdisciplinary professional committee, and (3) professionally and ethically interact with pharmaceutical representatives in daily practice.

J. Lewis Sigmon, MD
Geraldine D. Anastasio, PharmD
Department of Family Practice
Carolinas Medical Center
Charlotte, North Carolina