Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review
Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review
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DOI：
10.1371/journal.pmed.1000352
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发表时间：
2010-10-01
期刊：
影响因子：
15.8
通讯作者：
Vitry, Agnes I.
中科院分区：
文献类型：
--
作者：
Spurling, Geoffrey K.;Mansfield, Peter R.;Vitry, Agnes I.
背景：2004年，美国制药公司在药品促销上花费了575亿美元。业界声称促销为医生提供了科学和教育信息。虽然一些证据表明促销可能会对处方产生不利影响，但医生对药品促销持有不同的看法。本次综述的目的是考察制药公司信息的暴露与医生处方的质量、数量和成本之间的关系。方法和结果：我们检索了对拥有处方权、接触制药公司信息（促销或其他）的医生的研究。接触包括药品销售代表的拜访、期刊广告、参加药品赞助的会议、邮寄信息、处方软件以及参与赞助的临床试验。测量的结果是医生处方的质量、数量和成本。我们使用专家图书馆员制定的检索词检索了 Medline（1966 年至 2008 年 2 月）、International Pharmaceutical Abstracts（1970 年至 2008 年 2 月）、Embase（1997 年至 2008 年 2 月）、Current Contents（2001 年至 2008 年）和 Central（Cochrane 图书馆第 3 期，2007 年）。此外，我们还审查了参考文献列表并联系了专家和制药公司以获取信息。两位作者独立评估了评估制药公司信息和医生处方措施的随机和观察性研究的方法学质量。如果研究信息不足而无法进行评估，则研究被排除。从电子数据库（7,185 项研究）和其他来源（138 项研究）检索了 255 篇文章的全文。然后，由于不符合纳入标准 (179) 或质量评估标准 (18)，文章被排除，留下 58 项纳入研究和 87 项不同的分析。数据由两位作者独立提取，并按照 MOOSE 指南进行叙述综合。在检查处方质量结果的一组研究中，五项发现接触制药公司信息与较低质量处方之间存在关联，四项没有发现关联，一项发现与较低和较高质量处方之间存在关联。 38 项纳入的研究发现暴露与较高处方频率之间存在关联，而 13 项研究并未发现这种关联。五项纳入的研究发现了与较高成本相关的证据，四项发现没有相关性，一项发现与较低成本相关。对处方频率研究的荟萃分析发现了显着的异质性，支持了变量结果的叙述综合发现。大多数纳入研究的观察性是本次综述的主要限制。结论：除了极少数例外，对制药公司直接提供的信息的接触研究发现与较高的处方频率、较高的成本或较低的处方质量存在关联，或者没有发现显着的关联。我们没有找到处方方面净改善的证据，但现有文献并不排除处方有时可能得到改善的可能性。尽管如此，我们还是建议从业者遵循预防原则，避免接触制药公司的信息。
Background: Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.Methods and Findings: We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.Conclusions: With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.