Perceptions and Opinions of Canadian Hospital Executives: DISCUSSION
There was consensus among the respondents that changes in physician prescribing habits was the most important factor influencing demand for pharmaceuticals. The ranking of this factor was not affected by demographic characteristics. Interestingly, the methods that were perceived to best optimize the use of pharmaceuticals (clinical practice guidelines, disease management programs, and formulary management) are all used, at least in part, to influence prescribing. Pharmaceutical manufacturers are major sponsors of clinical practice guidelines and disease management programs. Both hospital executives and the pharmaceutical industry try to influence prescribing and medication use within the context of their respective organizations’ goals.
Strategies that focus on marketing or on the patient (or both) were perceived to be less important. For example, direct-to-consumer advertising, which has both a marketing and a patient focus, was perceived as the least important factor influencing demand for pharmaceuticals. Other marketing-related activities with a low ranking included drug (pharmaceutical) representatives and academic (counter) detailing. Patient-focused factors such as copayments and tiered formularies were perceived as the least valuable ways to optimize pharmaceutical use. This result may reflect the fact that the majority of respondents were working in institutional settings, where there is limited involvement of patients in their own care, especially with respect to payment for pharmaceuticals. In contrast, the Health Council of Canada found that direct-to-consumer advertising does influence both physician prescribing behaviour and patient demand. Although direct-to-consumer advertising is severely restricted in Canada, advertising of this type in the United States has a spillover or halo effect in Canada through print, broadcast, and electronic media. For example, in a study that evaluated the impact outside the United States of direct-to-consumer advertising in US media, 87.4% of consumers surveyed in Vancouver, British Columbia, had seen advertisements for prescription drugs. Moreover, while the return on investment to the pharmaceutical industry from this type of advertising is hard to ascertain because of the proprietary nature of the business, trends in expenditures by the industry suggest that companies believe it is effective in influencing customer behaviour and physician prescribing in some therapeutic categories. In the United States, spending on direct- to-consumer advertising for prescription drugs tripled between 1996 and 2000, when it reached nearly US$2.5 billion; by 2004, this figure exceeded US$4 billion. tadacip
A resource that is internal to respondents’ practice setting, the organization’s pharmacy department, was cited as the most frequently used source of information about pharmaceuticals and pharmaceutical policy. Conversely, with the exception of Health Canada, none of the national sources of information listed in the survey, such as the Canadian Institute for Health Information or the Canadian Agency for Drugs and Technologies in Health, were cited as frequent sources of this type of information. One might conclude that these responses were driven by the hospital-based respondents, who may rely on their institution’s own pharmacists. However, statistical analysis showed that the mean scores for sources of information were not significantly affected by any of the demographic characteristics. The fact that the Internet and the media were cited as frequently used may be worrisome, given concerns about the accuracy of pharmaceutical information from these sources. Despite all of the talk in health care circles about the value of evidence-based medicine, the Cochrane Collaboration was one of the two least used resources. Given that most of the survey respondents were not providers of direct patient care, it is perhaps unsurprising that they seem to rely on “lay” information sources. Hospital pharmacists can be encouraged that these executives rely on their staff (primarily their pharmacy departments) to become fully informed with respect to appropriate medication use.
Of the 3 key areas of concern identified by the National Pharmaceuticals Strategy, respondents thought that the second one, comprising issues of safety, effectiveness and appropriate use, was the most critical. Given that the study population consisted of executives and managers, it may be surprising that “pharmaceutical costs” was not cited as the most important issue. However, there was little distinction in perceived importance among the 11 factors listed in the survey (range 3.3 to 4.5 on a 5-point scale). buy revatio
