Date Published: April 24, 2007
Publisher: Public Library of Science
Author(s): Michael A Steinman, G. Michael Harper, Mary-Margaret Chren, C. Seth Landefeld, Lisa A Bero, Steven E Hyman
Abstract: BackgroundSales visits by pharmaceutical representatives (“drug detailing”) are common, but little is known about the content of these visits or about the impact of visit characteristics on prescribing behavior. In this study, we evaluated the content and impact of detail visits for gabapentin by analyzing market research forms completed by physicians after receiving a detail visit for this drug.Methods and FindingsMarket research forms that describe detail visits for gabapentin became available through litigation that alleged that gabapentin was promoted for “off-label” uses. Forms were available for 97 physicians reporting on 116 detail visits between 1995 and 1999. Three-quarters of recorded visits (91/116) occurred in 1996. Two-thirds of visits (72/107) were 5 minutes or less in duration, 65% (73/113) were rated of high informational value, and 39% (42/107) were accompanied by the delivery or promise of samples. During the period of this study, gabapentin was approved by the US Food and Drug Administration only for the adjunctive treatment of partial seizures, but in 38% of visits (44/115) the “main message” of the visit involved at least one off-label use. After receiving the detail visit, 46% (50/108) of physicians reported the intention to increase their prescribing or recommending of gabapentin in the future. In multivariable analysis, intent to increase future use or recommendation of gabapentin was associated with receiving the detail in a small group (versus one-on-one) setting and with low or absent baseline use of the drug, but not with other factors such as visit duration, discussion of “on-label” versus “off-label” content, and the perceived informational value of the presentation.ConclusionsDetail visits for gabapentin were of high perceived informational value and often involved messages about unapproved uses. Despite their short duration, detail visits were frequently followed by physician intentions to increase their future recommending or prescribing of the drug.
Partial Text: Visits to physician offices by pharmaceutical sales representatives are among the most visible and effective forms of drug industry promotion . As such, their role has generated substantial debate in the medical community [2–4]. Some commentators have argued that these “details” provide unbalanced information and thus negatively impact prescribing quality, a problem compounded by the influence of gifts that commonly accompany these interactions [5–10]. In addition, negative public perceptions of these relationships may harm the standing of the medical profession. Others have argued that sales representatives provide important information about drugs to physicians, and thus may improve prescribing quality [11–13].
In this study of drug detail visits for gabapentin, we found that most detail visits were brief and of high perceived quality, and often discussed unapproved uses of this drug. Moreover, after receiving the detail visit, half of participants reported the intention to increase their future prescribing or recommendation of gabapentin.