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Factors Influencing Prescribing

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					External Influences on
 Prescribing Practice



      Karen Ford
            Learning Outcomes
At the end of the session students will have

•   Examined the factors which might be considered to be
    external influences on prescribing practice.

• An increased awareness of those factors should enable
  students to prescribe in a more objective and evidence
  based way.
What are the factors likely to affect
   our prescribing decisions?

• Think of what might influence you when you start
  prescribing and then when you have been prescribing for
  five years.

• Make a note of those things you think about
Factors Influencing Prescribing

                                Policies
           Education                                Research


 Patient                                                   Marketing
                               Prescriber

                                                         Product
   Relatives
                                                          licence

                       Media                Peers
Some influences are positive ones
• Policies, guidelines
• Research evidence
• Cost and clinical effectiveness
      Other influences are not so
        positive? Or are they?

• The prescribers personal selection list (known
  as P drugs)

• Custom and practice

• Influence of opinion leaders, colleagues and
  peers
      Pharmaceutical Industry
           promotions
Companies promote their products to
  prescribers by:
• Direct mailing
• Adverts in journals
• Stands at events
• Seminars and educational meetings
              Advertising
• Promotional material is usually attractive
  and easy to digest.
• Tends to emphasis positive aspects of the
  product
• Tailored to appeal to specific groups of
  prescribers
 Advertising is, of course, not the
   only promotional tool used

Thinking point:

 What else is used to promote products?
  Look at your handout of MHRA
     advertising complaints
1. No Scientific evidence to support claims
   of this herbal medicine- ambiguous
   advertising
2. Promoting a POM to the public- what are
   the ethical issues here?
3. This complaint was not upheld do you
   think this was correct?
        Sponsorship and gifts
• How many “gifts” have you received in the last
  year?

• Did receipt of these gifts influence you in any
  way?
           Are we influenced ?
• Current cost of NHS drug spending 10 billion pounds per
  year

• 30 million per day

• 8,000 sales reps promote to 60,000 Drs =
  1 rep per 7.5 Drs

• It is very difficult to find out how much drug companies
  spend on promotions but think about drug rep salaries
  alone
       Sponsorship and gifts
• Standards of expected behaviour are
  identified within:
• NMC Code of Professional conduct
• Standards of business conduct for NHS
  staff (HSG (93) 5)
• The ABPI Code of Practice for the
  pharmaceutical industry 2006 (see link on
  Blackboard)
    NMC Code Of Professional
           Conduct
• 7 : AS A REGISTERED NURSE MIDWIFE OR
  HEALTH VISITOR YOU MUST:

• Be Trustworthy


  – You must ensure that your registration status is not
    used in the promotion of commercial products or
    services, declare any financial or other interests in
    relevant organisations providing such goods or
    services and ensure that your professional judgement
    is not influenced by any commercial considerations.
       Gifts and sponsorship
• Prescribers should maintain an
  independent stance to avoid accusations
  of inappropriate partiality to particular
  products being made.
How do you conduct a meeting with
             a rep?
• Take control of the discussion at the
  outset
• Look for more information than is given in
  the advert
• Make sure you get all the relevant info-
  drug trial info, cost and clinical
  effectiveness
• Copy of product characteristics
            What to ask for
• Copies of published articles
• Consider those from peer reviewed
  journals first
• Check what specialists in the field know
  about products
                        Gifts
• Should be worth no more than £5
• Relevant to practice
• The standard of any hospitality should be the same as
  you would routinely pay for yourself
• Only prescribers and not their family members should
  receive hospitality
REMEMBER

      There is no such thing
        as a free lunch!

      www.nofreelunch-uk.org
 So back to our learning outcomes
• What are the most powerful influences?
• How can we remain objective?
• What good habits can we form in order to
  keep us on the straight and narrow?
                Further Reading
• ABPI Code of Practice for the Pharmaceutical Industry 2006
  Available online @ www.abpi.org.uk
• Advertising of Medicines MHRA 2009 Available on line@
  www.mhra.org.uk
• House of Commons Health Committee Fourth Report of Session
  2004–05 -The Influence of the Pharmaceutical Industry Available on
  line@
  http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhea
  lth/42/42.pdf
• Pharmacy Journal Gifts & Inducements The Pharmaceutical
  Journal
  Vol 278 No 7457 p752
  23 June 2007
This work was produced as part of the TIGER project and funded by JISC and
the HEA in 2011. For further information see:
http://www.northampton.ac.uk/tiger.

This work by TIGER Project is licensed under a Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 Unported License. Based on a
work at tiger.library.dmu.ac.uk.

The TIGER project has sought to ensure content of the materials comply with
a CC BY NC SA licence. Some material links to third party sites and may use
a different licence, please check before using. The TIGER project nor any of
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