How do district nurses choose which products to prescribe?

[Nursing and industry relations: literature review and conflicts of interest survey]

BACKGROUND

Advanced competencies and tasks of nurses go along with an increasing interest of pharmaceutical companies and manufacturers in nurses as a marketing target.

OBJECTIVE

To identify nurses' attitudes, perceptions and behavior regarding industry and marketing strategies.

METHODS

1) Systematic literature search in Medline via PubMed and CINAHL for international studies on nurses' conflict of interests towards pharmaceutical companies; 2) analysis of a survey with PhD students from two Nursing Science doctoral programs.

RESULTS

The review including 16 publications published between 1999 and 2014 and the survey among 82 PhD students revealed comparable results. The majority of nurses already had contact with pharmaceutical companies. Nurses are often uncritical in their attitudes, and suggestibility is claimed to be low. The majority of nurses were not - or at least not sufficiently - provided with conflict of interest training, neither as part of their vocational training nor their continuing education.

CONCLUSION

Conflict of interest seems to be an important topic for nurses. Increasing relevance in the future underpins the need for making nurses more sensitive towards this issue, especially through professional training programs.

Interactions between non-physician clinicians and industry: a systematic review

BACKGROUND

With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice.

METHODS AND FINDINGS

We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis of this literature.

CONCLUSIONS

Non-physician clinicians' generally positive attitudes toward industry interactions, despite their recognition of issues related to bias, suggest that industry interactions are normalized in clinical practice across non-physician disciplines. Industry relations policy should address all disciplines and be implemented consistently in order to mitigate conflicts of interest and address such interactions' potential to affect patient care. Please see later in the article for the Editors' Summary.