Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries
Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries
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DOI：
10.1001/jamainternmed.2016.2765
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发表时间：
2016-08-01
影响因子：
39
通讯作者：
Dudley, R. Adams
中科院分区：
文献类型：
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作者：
DeJong, Colette;Aguilar, Thomas;Dudley, R. Adams
重要性 行业支付给医生的费用与正在推广的品牌药物的处方率之间的关联存在争议。在美国，行业支付数据和医疗保险处方记录最近已公开。 目的 研究医生接受行业赞助膳食（约占行业支付总数的 80%）与向医疗保险受益人开促销药物的比例之间的关联。 设计、设置和参与者 对联邦开放支付计划 8 月 1 日至 12 月 31 日的行业支付数据进行横断面分析， 2013 年，以及 Medicare D 部分中 2013 年全年个体医生的处方数据。参与者是开出 4 种药物类别中任何一种药物的 Medicare 处方的医生：他汀类药物、心脏选择性 β 受体阻滞剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂（ACE 抑制剂和 ARB），以及选择性血清素和血清素-去甲肾上腺素再摄取抑制剂（SSRI 和 SNRI）。我们确定了接受行业赞助餐食的医生，这些餐食推销的是每个类别中处方最多的品牌药物（分别为瑞舒伐他汀、奈必洛尔、奥美沙坦和去甲文拉法辛）。数据分析于 2015 年 8 月 20 日至 2015 年 12 月 15 日进行。 暴露 收到行业赞助的促销感兴趣药物的餐食。 主要结果和措施 在调整医生处方量、人口特征、专业和实践环境后，与同类替代药物相比，促销药物的处方率。 结果 共有 279 669 名医生接受了 63 524 笔付款与 4 种目标药物相关。 95% 的付款是餐费，平均价值不到 20 美元。瑞舒伐他汀占他汀类药物处方的 8.8%（SD，9.9%）；奈必洛尔占心脏选择性β受体阻滞剂处方的3.3%（7.4%）；奥美沙坦占ACE抑制剂和ARB处方的1.6%（3.9%）；去甲文拉法辛占 SSRI 和 SNRI 处方的 0.6% (2.6%)。接受单餐宣传感兴趣药物的医生开瑞舒伐他汀的比例高于其他他汀类药物（比值比 [OR]，1.18；95% CI，1.17-1.18），奈必洛尔高于其他 β 受体阻滞剂（OR，1.70；95% CI，1.69-1.72），奥美沙坦高于其他 ACE 抑制剂， ARB（OR，1.52；95% CI，1.51-1.53）和去甲文拉法辛优于其他 SSRI 和 SNRI（OR，2.18；95% CI，2.13-2.23）。接受额外膳食和接受花费超过 20 美元的膳食与较高的相对处方率相关。结论和相关性接受行业赞助的膳食与正在推广的品牌药物的处方率增加相关。研究结果代表了一种关联，而不是因果关系。
IMPORTANCE The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available.OBJECTIVE To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 drug classes: statins, cardioselective beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015.EXPOSURES Receipt of an industry-sponsored meal promoting the drug of interest.MAIN OUTCOMES AND MEASURES Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting.RESULTS A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3%(7.4%) of cardioselective beta-blocker prescriptions; olmesartan represented 1.6%(3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other beta-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.CONCLUSIONS AND RELEVANCE Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.