Physicians, pharmaceutical sales representatives, and the cost of prescribing

Objective: To evaluate the influence of primary care physicians' attitudes toward and use of information provided by pharmaceutical representatives on prescribing costs in ambulatory practice. Design: A mailed questionnaire collected information about physician demographic and practice characteristics and attitudes toward and use of information provided by pharmaceutical representatives. Participants: Kentucky physicians practicing primary care adult medicine (family medicine, general practice, general medicine; n=1603). Main Outcome Measure: Relative cost of prescribing, based on physician responses to treatment choices for ambulatory clinical scenarios in primary care. A multivariable regression model assessed predictive relationships between independent variables and prescription costs. Results: Four hundred forty-six returned questionnaires were suitable for analysis. No significant differences were noted in age, gender, days worked per week, or years since graduation between responders and a sample of nonresponders. A significant positive correlation was found between physician cost of prescribing and perceived credibility, availability, applicability, and use of information provided by pharmaceutical representatives (P<.01, Pearson's Product-Moment Correlation Coefficient). Physicians in academic or hospital-based practice settings had significantly lower prescribing costs than physicians in nonacademic and nonhospital practices (P=.001, analysis of variance). Frequency of use of information provided by pharmaceutical representatives (P=.01, multiple linear regression) and the group practice setting (P=.02, multiple linear regression) remained significant, independent positive predictors of cost in the multivariable regression model. Conclusions: Frequency of use of information provided by pharmaceutical representatives and the group practice, nonacademic and nonhospital setting may be associated with increased primary care physician prescribing costs.