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CME Released: 7/28/2005
Valid for credit through: 7/28/2006
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July 28, 2005 — Access to drug samples may influence resident physician prescribing, potentially increasing patients' costs, according to the results of a randomized trial reported in the July 28 issue of the American Journal of Medicine.
"There are few objective data describing how drug samples affect resident physicians," write Richard F. Adair, MD, and Leah R. Holmgren, MD, from the University of Minnesota and Abbott Northwestern Hospital in Minneapolis. "This is an important information gap, because drug samples are widely available in residents' clinics, and making treatment decisions based on which samples are available could affect both resident education and patient care. Although samples may provide short-term economic benefit for some patients, their primary purpose is to market new and expensive drugs."
During a six-month period in an inner-city primary care clinic, the authors observed 390 decisions by 29 internal medicine residents to begin drug therapy for patients. The residents were randomized either to not use available free drug samples or to use them at their discretion. Five drug-class pairs were chosen for study prospectively, with highly advertised drugs matched with drugs commonly used for the same indication but in less-expensive, over-the-counter (OTC), or generic formulations.
Compared with residents without access to drug samples, those with access to samples were less likely to choose unadvertised drugs (131 of 202 decisions vs 138 of 188 decisions; P = .04) and less likely to choose OTC drugs (51 of 202 vs 73 of 188; P = .003). There was also a nonsignificant trend toward less use of inexpensive drugs.
"Access to drug samples in clinic influences resident prescribing decisions," the authors write. "This could affect resident education and increase drug costs for patients."
Study limitations include small sample size, finding significant differences only for groups of drugs, nonintrusive study methods limiting the ability to analyze how samples affected decisions to start individual drugs, failure to evaluate appropriateness of prescribing, and effect of local factors.
"Access to drug samples influenced prescribing decisions of resident physicians, something that would seem to violate published national guidelines on physician interactions with the pharmaceutical industry," the authors conclude. "This finding contradicts two widespread beliefs: Drug samples are inherently different from other forms of marketing, and samples help patients manage drug costs in the long term. They raise questions about whether drug samples belong in clinics where residents are learning or where low-income patients are receiving care."
Am J Med. 2005;118:881-884
