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Medlinskiene K, Tomlinson J, Marques I, Richardson S, Stirling K, Petty D. Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic review. BMC Health Serv Res 2021; 21:1198. [PMID: 34740338 PMCID: PMC8570007 DOI: 10.1186/s12913-021-07196-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research. METHOD A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them. RESULTS A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored. CONCLUSION This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines. REGISTRATION PROSPERO database (CRD42018108536).
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Affiliation(s)
- Kristina Medlinskiene
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Justine Tomlinson
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Iuri Marques
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
| | - Sue Richardson
- Department of Management, Huddersfield Business School, University of Huddersfield, Huddersfield, HD1 3DH UK
| | - Katherine Stirling
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Duncan Petty
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
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Md Hamzah N, See KF. Differential diffusion of pharmaceutical innovations in a mixed market middle - income economy. BMC Health Serv Res 2021; 21:1119. [PMID: 34663311 PMCID: PMC8524869 DOI: 10.1186/s12913-021-06786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Policymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion. Methods We matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics. Results The utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category. Conclusions Understanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06786-6.
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Affiliation(s)
- Nurhafiza Md Hamzah
- Planning Division, Ministry of Health Malaysia, Federal Administrative Centre, Level 3, Block E6, E Complex, 62590, Putrajaya, Malaysia.
| | - Kok Fong See
- Economics Programme, School of Distance Education, Universiti Sains Malaysia, 11800, Minden, Pulau Pinang, Malaysia.
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Inoue R, Nishi H, Inoue D, Honda K, Nangaku M. Regional Variance of the Early Use of Tolvaptan for Autosomal Dominant Polycystic Kidney Disease. ACTA ACUST UNITED AC 2020; 1:740-745. [DOI: 10.34067/kid.0002262020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
BackgroundThe development and prompt dissemination of the first drug against a particular disease can contribute to improvements in national health status and medical economy end points and are assumedly affected by socioeconomic factors that have yet to be analyzed. Tolvaptan, a vasopressin receptor 2 antagonist, was developed to treat hyponatremia, congestive heart failure, and cirrhosis ascites, although the approved indications may differ among countries. In Japan, high-dose tolvaptan tablets were approved as the first drug for autosomal dominant polycystic kidney disease (ADPKD) in 2014. This study aimed to better understand the factors that influence the total number of regional prescriptions of tolvaptan for ADPKD since its launch.MethodsThe National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data was used as a national claim-based database. In each of the 47 prefectures in Japan, the total prescribed number of 30 mg tolvaptan tablets between 2015 and 2017 was examined. The parameters explaining the prescription variation among regions were then examined by correlation analysis.ResultsPrescriptions for high-dose tolvaptan increased substantially 2 years after the drug’s approval; however, the increase differed by approximately 21-fold between regions. Population density was positively associated with prescribed 30 mg tolvaptan tablets per 1000 population in 2015 (r=0.47, P<0.001). In addition, the increase in prescribed number of tablets per 1000 population was correlated with population density in 2016–2017 (r=0.30, P=0.04).ConclusionsThis macro perspective analysis revealed an urban-rural inequity in prescriptions for the newly approved drug for ADPKD. Further studies are needed to elucidate the factors affecting the geographic variation.
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Dowling S, Last J, Finnegan H, Bourke J, Daly P, Hanrahan C, Harrold P, McCoombe G, Cullen W. How does small group continuing medical education (CME) impact on practice for rural GPs and their patients, a mixed-methods study. EDUCATION FOR PRIMARY CARE 2020; 31:153-161. [PMID: 32089106 DOI: 10.1080/14739879.2020.1728704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care.
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Affiliation(s)
- Stephanie Dowling
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - J Last
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - H Finnegan
- Irish College of General Practice, Dublin, Ireland
| | - John Bourke
- Irish College of General Practice, Dublin, Ireland
| | - Pat Daly
- Irish College of General Practice, Dublin, Ireland
| | | | - Pat Harrold
- Irish College of General Practice, Dublin, Ireland
| | - Geoff McCoombe
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - W Cullen
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
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Dowling S, Last J, Finnegan H, Daly P, Bourke J, Hanrahan C, Harrold P, McCombe G, Cullen W. Impact of participation in continuing medical education small group learning (CME-SGL) on the stress, morale, and professional isolation of rurally-based GPs: a qualitative study in Ireland. BJGP Open 2019; 3:bjgpopen19X101673. [PMID: 31662316 PMCID: PMC6995863 DOI: 10.3399/bjgpopen19x101673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The pressures of general practice contribute to high levels of stress, low morale, and burnout in some GPs. In addition, rurally-based doctors may experience significant professional isolation. Participation in continuing medical education (CME) appears to reduce stress, and may improve the retention of rural GPs. AIM As part of a larger study devised to examine the effectiveness of regular participation in CME small group learning (SGL) on rurally-based Irish GPs, this study explored whether CME-SGL had any impact on GP stress, morale, and professional isolation. DESIGN & SETTING This was a qualitative study involving four CME-SGL groups based in rural Ireland. METHOD Semi-structured focus group interviews were conducted in established CME-SGL groups in four different rural geographical locations. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. RESULTS All members of these CME-SGL groups (n = 43) consented to interview. These GPs reported that regular meetings with an established group of trusted colleagues who are 'in the same boat' provided a 'safe space' for discussion of, and reflection on, both clinical concerns and personal worries. This interaction in a supportive, non-threatening atmosphere helped to relieve stress, lift morale, and boost self-confidence. The social aspect of CME-SGL sustained these rural GPs, and served to alleviate their sense of professional isolation. CONCLUSION Delivery of CME through locally-based SGL provides as an important means of supporting GPs working in rural areas. The non-educational benefits of CME-SGL, as described by these Irish GPs, are of relevance for rural doctors in other countries.
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Affiliation(s)
- Stephanie Dowling
- ICGP Assistant National Academic Director of CME, Irish College of General Practitioners, Dublin, Ireland
- Research Student, Health Sciences Centre, University College Dublin School of Medicine, Dublin, Ireland
| | - Jason Last
- Associate Dean, Director of Education Development and Academic Affairs, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Henry Finnegan
- Former National Director of ICGP CME (retired), Irish College of General Practitioners, Dublin, Ireland
| | - Pat Daly
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - John Bourke
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Conor Hanrahan
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Pat Harrold
- ICGP CME Tutor, Irish College of General Practitioners, Dublin, Ireland
| | - Geoff McCombe
- Post-doctoral Research Fellow, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- Professor of Urban General Practice and Head of Subject, General Practice, University College Dublin School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Metes ID, Xue L, Chang CCH, Huskamp HA, Gellad WF, Lo-Ciganic WH, Choudhry NK, Richards-Shubik S, Guclu H, Donohue JM. Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending. BMC Health Serv Res 2019; 19:703. [PMID: 31619229 PMCID: PMC6794771 DOI: 10.1186/s12913-019-4520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.
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Affiliation(s)
- Ilinca D Metes
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Lingshu Xue
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Chung-Chou H Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Walid F Gellad
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15215, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Seth Richards-Shubik
- College of Business and Economics, Lehigh University, Rausch Business Center, Room 465, 621 Taylor St, Bethlehem, PA, 18015, USA
| | - Hasan Guclu
- Department of Statistics, School of Science, Istanbul Medeniyet University, Uskudar, 34700, Istanbul, Turkey
| | - Julie M Donohue
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA, 15261, USA.
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Dowling S, Last J, Finnegan H, O'Connor K, Cullen W. What are the current 'top five' perceived educational needs of Irish general practitioners? Ir J Med Sci 2019; 189:381-388. [PMID: 31190220 DOI: 10.1007/s11845-019-02047-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Doctors' continuing medical educational and professional development (CME and CPD) needs are known to be strongly influenced by national and local contextual characteristics. A crucial step in the development of effective education and training programmes is the assessment of learner needs. METHODS A national needs assessment was conducted among general practitioners (GPs) in the Republic of Ireland who attended continuing medical education small group learning meetings (CME-SGL) in late 2017. Doctors completed a self-administered anonymous three-page questionnaire which gathered demographic data and asked them to choose their 'top five' perceived educational needs from separate lists of topics for CME and CPD. RESULTS There were 1669 responses (98% of monthly attendance). The topics most commonly identified as a priority for further CME were prescribing (updates/therapeutics), elderly medicine, management of common chronic conditions, dermatology, and patient safety/medical error. The most commonly selected CPD topics were applying evidence-based guidelines to practice, appraising performance/conducting practice audits, coping with change, and managing risk and legal medicine. There was no difference between urban and rural practice settings regarding the most commonly chosen topics in each category; however, more rural GPs selected pre-hospital/emergency care as one of their 'top five'. CONCLUSION Our findings identified priority areas where CME and CPD for GPs in Ireland should focus. The topics selected may reflect the changing nature of general practice, which increasingly requires delivery of care to an ageing population with more multi-morbidity and chronic disease management, while trying to apply evidence-based medicine and consider patient safety issues. CME/CPD programmes need to adapt accordingly.
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Affiliation(s)
- Stephanie Dowling
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland.
- Cappoquin Health Centre, West Waterford, Ireland.
| | - Jason Last
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland
| | - Henry Finnegan
- Irish College of General Practice National CME Director, Irish College of General Practice, Dublin, Ireland
| | | | - Walter Cullen
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland
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DEDEHAYIR OZGUR, ORTT ROLANDJ, RIVEROLA CARLA, MIRALLES FRANCESC. INNOVATORS AND EARLY ADOPTERS IN THE DIFFUSION OF INNOVATIONS: A LITERATURE REVIEW. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2017. [DOI: 10.1142/s1363919617400102] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite accounting for a very small percentage of the population that adopts an innovation, the ‘innovators’ and ‘early adopters’ — representing the two earliest groups of individuals to acquire the new product or service — play a crucial role in the dissemination of the innovation to larger market segments. The objective of this paper is to understand the characteristics of these individuals that positively influence their decisions to adopt innovations. We argue that awareness of these traits will enable firms to attain speedier uptake of their offerings while aiding policymakers achieve quicker and wider proliferation of new technologies intended for societal benefit. We undertake a review of the literature studying the diffusion of innovations and show future directions that this framework should take to analyse the adoption lifecycle.
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Affiliation(s)
- OZGUR DEDEHAYIR
- Queensland University of Technology, 2 George Street, 4000 Brisbane, Australia
| | - ROLAND J. ORTT
- Delft University of Technology, Jaffalaan 5, 2628 BX Delft, The Netherlands
| | - CARLA RIVEROLA
- La Salle — Universitat Ramon Llull, Sant Joan la Salle 42, Barcelona 08022, Spain
| | - FRANCESC MIRALLES
- La Salle — Universitat Ramon Llull, Sant Joan la Salle 42, Barcelona 08022, Spain
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Unwinding the State subsidisation of private health insurance in Ireland. Health Policy 2015; 119:1349-57. [DOI: 10.1016/j.healthpol.2015.08.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 07/02/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022]
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Prescribing and practice development decision-making in Irish general practices. Ir J Med Sci 2015; 184:591-6. [DOI: 10.1007/s11845-015-1326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Lublóy Á. Factors affecting the uptake of new medicines: a systematic literature review. BMC Health Serv Res 2014; 14:469. [PMID: 25331607 PMCID: PMC4283087 DOI: 10.1186/1472-6963-14-469] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The successful diffusion of new drugs is crucial for both pharmaceutical companies and patients-and of wider stakeholder concern, including for the funding of healthcare provision. Micro-level characteristics (the socio-demographic and professional characteristics of medical professionals), meso-level characteristics (the prescribing characteristics of doctors, the marketing efforts of pharmaceutical companies, interpersonal communication among doctors, drug attributes, and the characteristics of patients), and macro-level characteristics (government policies) all influence the diffusion of new drugs. This systematic literature review examines the micro- and meso-level characteristics of early prescribers of newly introduced drugs. Understanding the characteristics of early adopters may help to speed up the diffusion process, promote cost-efficient prescribing habits, forecast utilisation, and develop targeted intervention strategies. METHODS The PubMed and Scopus electronic databases were chosen for their extensive coverage of the pertinent literature and used to identify 205 potentially relevant studies by means of a four-layered search string. The 35 studies deemed eligible were then synthetized carefully and critically, to extract variables relevant to this review. RESULTS Early adoption of new drugs is not a personal trait, independent of drug type, but early adopters share both micro- and meso-level characteristics. At prescriber level, doctors' interest in particular therapeutic areas, participation in clinical trials, and volume of prescribing-either in total or within the therapeutic class of the new drug-increase the likelihood of early adoption. The marketing efforts of pharmaceutical companies and doctors' professional and social interactions leading to prescribing contagion are very powerful predictors of new drug uptake. At patient level, doctors with younger patients, patients with higher socioeconomic statuses and/or patients with poorer health statuses are more inclined to prescribe new drugs early. In contrast, the socio-demographic characteristics of prescribers and many practice-related factors play little role in the adoption process. CONCLUSIONS The most powerful predictors of new drug uptake include the doctors' strong scientific commitment, high prescribing volume in total or in within the therapeutic class of the new drug, high exposure to marketing, and intense communication with colleagues.
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Affiliation(s)
- Ágnes Lublóy
- Department of Finance, Institute of Finance and Accounting, Corvinus University of Budapest, Fővám tér 8, Budapest 1093, Hungary.
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The influence of experiential learning on medical equipment adoption in general practices. Health Policy 2014; 118:37-47. [DOI: 10.1016/j.healthpol.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022]
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Premium inflation in the Irish private health insurance market: drivers and consequences. Ir J Med Sci 2013; 182:545-50. [DOI: 10.1007/s11845-013-0929-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
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