Healthy Skepticism Library item: 6796
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Publication type: Journal Article
Powers RL, Halbritter KA, Arbogast JG, Neely JL, Williams AJ.
Do interactions with pharmaceutical representatives influence antihypertensive medication prescribing practices of family medicine and general internal medicine physicians?
Journal of General Internal Medicine 1998; 13:13
Abstract:
US physicians’ prescribing practices for the estimated 50 million people with hypertension have significant therapeutics and fiscal consequences. Although the available pharmacologic agent are similar in their blood pressure lowering effect, significant differences exist in side effects, costs and evidence supporting mortality reduction. Despite the 1993 Fifth Joint National Committee (JNC V) recommendation that hydrochlorothiazide and Beta-blockers be used as first choice agents “unless they are contraindicated or unacceptable,†a recent study showed increased use of ACE inhibitors and calcium antagonists and decreased use of diuretics and beta blockers between 1992 and 1995. This study examines physician behaviors via a survey of Family Medicine
(FM) and General Internal Medicine (GIM) faculty and residents and reviews actual prescribing practices. The response rate was 57% (n = 63: FM 29, GIM 34). The provision of information by pharmaceutical representatives at the work site was reported to be significantly higher for FM than GIM (86% vs 13% >1x per week). Journal articles and lectures were most commonly cited by both groups as their main source of information about antihypertensive therapy, but differences were noted in the reliance on JNC V (24% vs 45%), colleagues (41% vs 27%) and pharmaceutical representatives (25% vs 9%) by FM
and GIM respectively. FM physicians are significantly more likely than GIM to include ACE inhibitors and/or calcium antagonists as initial therapy for a healthy 45 yr old with hypertension (45% vs 12%, p<0.05). Diuretics and Beta-blockers were selected with similar frequency (83% vs 97%). Computerized medication lists of hypertensive patients (without coexisting diabetes mellitus, congestive heart failure, asthma or chronic obstructive pulmonary disease) were reviewed for actual prescribing practices. Of 4450 antihypertensives prescribed by FM and GIM, ACE inhibitors and/or calcium antagonists accounted for 53% nd 46%, respectively, and diuretics and/or Beta-blockers accounted for 39% and 47%. Analysis found FM to be significantly more likely than GIM to prescribe ACE inhibitors and/or
calcium antagonists than diuretics and/or Beta-blockers (p<0.01).
This study of academic physicians found that those physicians reporting the greatest amount of interaction with pharmaceutical representatives are significantly more likely to prescribe ACE inhibitors and/or calcium antagonists for their hypertensive patients than physicians reporting low levels of interaction.
Keywords:
*analytic survey/United States/physicians in training/ quality of prescribing/ primary care doctors/ internists (physicians)/ source of information/ hypertension/sales representatives/INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE/PROMOTION AS A SOURCE OF INFORMATION: DOCTORS/PROMOTION AS A SOURCE OF INFORMATION: PHYSICIANS IN TRAINING
Notes:
Methodology note: There is the possibility of a social acceptability bias. No details are given how the sample was chosen and therefore the generalizability is unknown. The results reflect prescribing practices for hypertension and may not be applicable to other diseases.
