Canadian Nurse Practitioners and Pharmaceutical Influences

1. Canadian Nurse Practitioners and Pharmaceutical Influences Dr Kimberley Lamarche RN NP, DNP

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3. Prescription decision making is a complex process influenced by other factors in addition to scientific knowledge (Ladd, Mahoney, and Srinivas (2010). The influence of pharmaceutical industry sponsored education, promotions and gifts on the prescribing practices of physicians and medical students has been well documented in the literature. However, the effect of corporate promotions on the prescribing practices of nurse practitioners has not been assessed. (Muncy-Blunt, 2010)

4. The specific objectives of this replication study are to assess Canadian Nurse Practitioners’ (NPs) interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors (Ladd, Mahoney, and Srinivas, 2010).

5. Background “There is a large and critical gap in the current literature regarding the pharmaceutical industry's influence on NP prescribing patterns (Ladd, Mahoney & Srinivas 2010)”. Not only has there been less than five NP based studies, but none of these have been Canadian based, where the pharmaceutical industry is different than that of other markets studied (Crigger N, Barnes K, Junko A, Rahal S, Sheek C, 2009). One of the primary differences in terms of Canadian NPs is the challenge of non-sample permission. Much of NPs' prescription writing is invisible, and difficult to track, thereby making it difficult to assess the degree to which pharmaceutical companies affect NPs' prescriptions (Diamond, 2003).

6. Canadian Context One of the primary differences in terms of Canadian NPs is the challenge of non-sample permission. Free samples have been shown to affect physician prescribing behavior. Physicians with access to free samples are more likely to prescribe brand name medication over equivalent OTC medications (Sifrin & Ross, 2008.) This study also found that free samples decreased the likelihood that physicians would follow standard of care practices. Although these reasons are not the reason why Canadian NPs are not currently permitted to dispense samples, it does have a bearing when interpreting research results from other countries.

7. Comparisons with Previous Studies In spite of the differences, it is likely that pharmaceutical companies do influence NPs' prescribing practices. Much of NPs' prescription writing is invisible, and difficult to track, thereby making it difficult to assess the degree to which pharmaceutical companies affect NPs' prescriptions (Diamond, 2003). There is literature reporting that physician pharmaceutical prescribing behavior is influenced by pharmaceutical interventions (Ladd, Mahoney & Srinivas 2010, Lewis, 2007; Greene, 2007; Sidiqi, 2006). Comparisons however cannot be made across disciplines, and this likely is the impetus for more targeted published opinion articles and studies related to NPs and in some cases Physician Assistants (Blunt 2010, Crigger 2004, Lee, 2006; Sidiqi, 2006; Ladd et al., 2010). These studiesindicated that although NPs acknowledge that there is a positive relationship with pharmaceutical interventions they do not purport that these interactions have any negative impact on their prescribing habits.

9. According to the Canadian Food and Drug Act, as of Jan 2012, in your current understanding are NPs authorized to currently dispense samples?

10. Do NPs in your practice currently dispense drug samples?

11. Pharmaceutical marketing has become ubiquitous in today's society. Acquisition of nonbiased, evidence-based information on drugs is essential for prescribers and is a key component of continuing professional development in the health professions. Prescription decision making is a complex process influenced by other factors in addition to scientific knowledge (Ladd, Mahoney, and Srinivas (2010). The influence of pharmaceutical industry sponsored education, promotions and gifts on the prescribing practices of physicians and medical students has been well documented in the literature. However, the effect of corporate promotions on the prescribing practices of nurse practitioners has not been assessed. (Blunt, E., 2010)

12. There is a large and critical gap in the current literature regarding the pharmaceutical industry's influence on NP prescribing patterns. Data demonstrate that NP practice is influenced by their interactions with pharmaceutical companies. It is unclear from the literature, both grey and evidenced based if the majority of NPs believe that this influence affects their prescribing practice – either positively or negatively. Prescriber contact and interface with pharmaceutical industry promotions have been found to contribute to non–evidence-based prescribing by physician and NPs.

13. This study is a replication of a study with NPs in the United States (Ladd, Mahoney & Srinivas, 2010) and is being conducted with the permission of the original author. The specific objectives of study are to assess Canadian NPs interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors. This study will be accomplished through a self-administered online survey using a sample of Canadian nurse practitioners. What are the prescribing behaviors and beliefs of advanced practice nurses in relation to pharmaceutical marketing practices? What are the factors that influence prescribing behaviors in relation to pharmaceutical marketing practices?

14. References CriggerN, Barnes K, Junko A, Rahal S, Sheek C. Nurse practitioners' perceptions and participation in pharmaceutical marketing. J AdvNurs. 2009;65(3):525-533.Diamond F (2003). Nurse practitioners inch onto the field. Managed Care Magazine. Hall, KB, Tett, SE., & Nissen, LM. Perceptions of the influence of prescription medicine samples on prescribing by family physicians. Med Care, Vol 44(4), April 2006, 383-387. JutelA, Menkes DB. Soft targets: nurses and the pharmaceutical industry. PLoS Med. 2008 Feb; 5(2):e5. Ladd, E., Mahoney, D., and Srinivas, E. (2010). Under the Radar: Nurse Practitioner Prescribers and Pharmaceutical Industry Promotions. American Journal of Managed Care; 16(12 Lee, S. (2006). Invisible Prescribers: What you don’t know about NPs and Pas. Pharmaceutical Executive; 26 (3) pg 88 -92. Lewis, PR. Advertising, sponsorship, and conflict of interest. J Family Practice. 56(5):344, May 2007. Morris L, Taitsman JK. The agenda for continuing medical education: limiting industry's influence. N Engl J Med 2009;361(25): 2478-2482 Muncy-Blunt E. The influence of pharmaceutical company sponsored educational programs, promotions and gifts on the self-reported prescribing beliefs and practices of certified nurse practitioners in three states [Drexel theses and dissertations]. March 17, 2005. Pegler, S. & Underhill, J. Evaluating promotional material from industry: an evidence-based approach. Pharmaceutical Journal, March 5, 2005, 274, 271-274. Sidiqi, S. (2006). Pharmaceutical Influence?. The Nurse Practitioner; 28 (5). Spurling, G. & Mansfield, P. General practitioners and pharmaceutical sales representatives: quality improvement research. Quality & Safety in Health Care. 16(4): 266-70. 2007. Sufrin CB, Ross JS (September 2008). "Pharmaceutical industry marketing: understanding its impact on women's health". ObstetGynecolSurv 63 (9): 585–96

15. Dr Kimberley Lamarche, RN NP, DNP lamarche@athabascau.ca 1 902 539 1519