Japanese Practicing Physicians' Relationships with Pharmaceutical Representatives: A National Survey

BackgroundPrevious surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors.
Methods and FindingsFrom January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand-name medications.
ConclusionsInvolvement in pharmaceutical promotional activities is widespread among practicing physicians in Japan. The extent of such involvement varies according to certain physician characteristics. As a group, they are at risk for influence by promotional activities.

研究背景
既往针对医师与医药代表（Pharmaceutical Representatives，PRs）之间关系开展的调查，质量均较为有限。本研究针对日本在职医师开展调查，旨在评估其参与医药推广活动的程度、可预测此类参与行为的医师特征、对与医药代表关系的态度、参与程度与态度之间的相关性，以及根据自我报告的处方行为划分的参与程度差异。

研究方法与结果
2008年1月至3月，我们针对涵盖内科、普通外科、骨科、儿科、妇产科、精神科及眼科的7个专科的2621名在职医师开展了全国性调查，本次调查的应答率为54%。绝大多数医师会与医药代表会面（98%）、领取药品样品（85%）及文具（96%），并参与企业赞助的职场内继续医学教育（Continuing Medical Education，CME）活动（80%）及职场外继续医学教育活动（93%）。有半数医师接受职场外聚餐邀请（49%），以及参加继续医学教育活动的经费补贴（49%）。职场内禁止与医药代表会面及收取礼品的规定，可预示医师参与推广活动的程度更低。医师对医药代表提供的信息较为重视。他们认为自身不太会受推广活动影响，但认为同事比自己更易受此类影响。对于低价值礼品的合理性，医师群体存在分歧。医师参与推广活动的程度，与"医药代表是有价值的信息来源"及"礼品具有合理性"这两种态度呈正相关。当有新药上市时倾向于向医药代表咨询信息的医师、对仅以建议结束接诊的患者随访感到不满的医师，以及偏好开具品牌药物的医师，其参与推广活动的程度更高。

研究结论
在日本在职医师群体中，参与医药推广活动的现象十分普遍。此类参与程度因部分医师特征而异。整体而言，该群体存在受推广活动影响的风险。