Association between physicians' interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis.
Association between physicians' interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0175493
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Akl EA
中科院分区：
文献类型：
--
作者：
Brax H;Fadlallah R;Al-Khaled L;Kahale LA;Nas H;El-Jardali F;Akl EA
制药公司代表可能会影响医生的处方习惯和职业行为。本研究的目的是系统地回顾医生与制药公司的互动与他们的临床实践之间的关联。我们使用了标准的系统评价方法。观察性和实验性研究设计检查执业医师和制药公司之间的任何类型的有针对性的相互作用是合格的。检索策略包括检索截至2016年7月的MEDLINE和EMBASE数据库。两名评审员选择研究，提取数据，并独立地评估偏倚风险。我们使用GRADE方法评估证据质量。20篇文章报告了19项研究，符合我们的纳入标准。所有这些研究都在高收入国家进行，并检查了不同类型的互动，包括详细说明，行业资助的继续医学教育和接受免费礼物。虽然所有研究都评估了处方行为，但四项研究还评估了财务结果，一项评估了医生的知识，一项评估了他们的信念。这些研究均未评估临床结局。在19项研究中，15项发现促进药物的相互作用与不适当地增加处方率，降低处方质量和/或增加处方成本之间存在一致的关联。其余四项研究发现，研究中检查的不同类型的暴露和药物既有关联，也没有显著关联。其中6项研究的荟萃分析发现，暴露与医生处方行为之间存在统计学显著相关性（OR = 2.52; 95%CI 1.82 - 3.50）。由于偏倚和不一致的风险，证据质量被降级为中度。排除高偏倚风险研究的敏感性分析并没有实质性改变这些结果。亚组分析未发现暴露类型的差异。有中等质量的证据表明，医生与制药公司的互动与他们的处方模式和质量有关。
Pharmaceutical company representatives likely influence the prescribing habits and professional behaviors of physicians. The objective of this study was to systematically review the association between physicians’ interactions with pharmaceutical companies and their clinical practices. We used the standard systematic review methodology. Observational and experimental study designs examining any type of targeted interaction between practicing physicians and pharmaceutical companies were eligible. The search strategy included a search of MEDLINE and EMBASE databases up to July 2016. Two reviewers selected studies, abstracted data, and assessed risk of bias in duplicate and independently. We assessed the quality of evidence using the GRADE approach. Twenty articles reporting on 19 studies met our inclusion criteria. All of these studies were conducted in high-income countries and examined different types of interactions, including detailing, industry-funded continuing medical education, and receiving free gifts. While all included studies assessed prescribing behaviors, four studies also assessed financial outcomes, one assessed physicians’ knowledge, and one assessed their beliefs. None of the studies assessed clinical outcomes. Out of the 19 studies, 15 found a consistent association between interactions promoting a medication, and inappropriately increased prescribing rates, lower prescribing quality, and/or increased prescribing costs. The remaining four studies found both associations and lack of significant associations for the different types of exposures and drugs examined in the studies. A meta-analysis of six of these studies found a statistically significant association between exposure and physicians’ prescribing behaviors (OR = 2.52; 95% CI 1.82–3.50). The quality of evidence was downgraded to moderate for risk of bias and inconsistency. Sensitivity analysis excluding studies at high risk of bias did not substantially change these results. A subgroup analysis did not find a difference by type of exposure. There is moderate quality evidence that physicians’ interactions with pharmaceutical companies are associated with their prescribing patterns and quality.