Drug sample provision and its effect on continuous drug therapy in an indigent care setting

Use of Prescription Drug Samples in the USA: A Descriptive Study with Considerations for Pharmacoepidemiology

INTRODUCTION

Free prescription drug samples provided in physician offices can lead to exposure misclassification in pharmacoepidemiologic studies that rely on pharmacy claims data.

METHODS

We quantified drug-specific sample provision rates based on nationally projected data from a survey of over 3200 US office-based physicians for 1993-2013.

RESULTS

Between 2009 and 2013, a total of 44.7 % of newly initiated brand-only sitagliptin but only 3.6 % of generically available metformin therapy was provided as samples. We observed similar discrepancies between newly initiated rosuvastatin and simvastatin, dabigatran and warfarin, atomoxetine and methylphenidate, and between oral antibiotic drugs. During continued therapy, sample use was still present though to a lesser extent (sitagliptin 17.0 %, rosuvastatin 23.9 %), and remained high for some oral contraceptives (norethindrone 55.8 %). Oral contraceptives had the longest average days of sample supply (levonorgestrel, continued use 85.1 days). The average days of supply for all other chronically used study drugs ranged from 13.4 (dabigatran, new use) to 25.3 (exenatide, continued use) per sample provided. From 1993 to 2013, we found pronounced drops in sample provisions over time coinciding with more recent generic approval dates.

CONCLUSIONS

We observed markedly differential exposure to medication samples between branded and generic drugs. This can introduce bias in pharmacoepidemiologic studies, especially when adverse events that occur soon after drug initiation are of interest.

National survey of pharmacy services in free medical clinics

OBJECTIVES

To characterize the current model of pharmacy services in free clinics, identify the extent to which free clinics serve as training sites for student pharmacists and residents, elucidate pharmacy service gaps in free clinics, and compare results to a 2001 survey.

DESIGN

Descriptive, non-experimental, cross-sectional study.

SETTING

Free medical clinics in the United States in early 2008.

PARTICIPANTS

Clinics registered at www.freeclinicfoundation.org.

INTERVENTION

A 26-point questionnaire addressed clinic and pharmacy demographics, pharmacy services, medication storage and distribution processes, and systems management. Survey invitations were sent via postal mail, with responses submitted via hardcopy or online (Survey Monkey). Nonresponders received a second mailing 4 weeks later.

MAIN OUTCOME MEASURES

Characteristics determined by survey responses.

RESULTS

42% of clinics responded (216 of 518). The median annual clinic budget was $145,000, with 1% to 20% spent on medications. Of responding clinics, 30% had a licensed pharmacy that was staffed on average by 3.4 pharmacist volunteers and 0.1 pharmacist employees. Of the 83.5% (177 of 212) that dispensed drugs, clinics filled 67 prescriptions per day with cardiovascular, gastrointestinal, and anti-infective agents as top classes. Pharmacy personnel provided mainly traditional (e.g., distributive) services (61.1%), and 19.3% of clinics trained student pharmacists. Since 2001, the number of clinics (355 vs. 518) and prescriptions dispensed (29 vs. 67 per day) increased but the percentage with a licensed pharmacy (33% vs. 30%) and mean number of pharmacist volunteers/employees (3.8/0.1 vs. 3.4/0.1) remained constant.

CONCLUSION

The model of free clinic pharmacy services is a modified community practice. Pharmacy personnel have the opportunity to expand their role and pharmacy practice in free clinics.

Perceived advantages and disadvantages of using drug samples in a university hospital center: a case study

BACKGROUND

The distribution of drug samples is both permitted and a common practice in Canada and the US. The impact of this strategy on healthcare workers' opinions and habits is a reason for concern.

OBJECTIVE

To evaluate the perceived advantages and disadvantages of using drug samples in a university hospital center.

METHOD

An observational, descriptive case study was conducted in a 500-bed university hospital center between October 18 and November 1, 2007. To obtain feedback from the healthcare staff, our research team, which was made up of a physician, pharmacy resident, 2 pharmacists, and a student in health administration, designed a 26-question survey using a Likert scale (fully agree, partially agree, partially disagree, totally disagree, do not know). The questions focused on 8 different variables (rapid treatment initiation, free cost and availability, practicality of use, patient risk, pharmacist's role, impact on choice of treatment, storage and stock management, risk of pilfering).

RESULTS

In total, 39 physicians, 18 medical residents, 17 medical clerks, 83 nurses, and 23 pharmacists working in various healthcare units and outpatient clinics (N = 180) agreed to take part in the survey and fill out the questionnaire. Generally speaking, there was a high degree of variation among the professional groups in their levels of agreement with the statements on the questionnaire. For example, 71% of the nurses, 43% of the physicians, 71% of the medical residents, and 36% of the medical clerks believed that drug samples encouraged treatment adherence, whereas only 17% of the pharmacists were of this opinion.

CONCLUSIONS

Our results show that the perceived advantages and risks of using drug samples vary by healthcare provider group and in terms of exposure or nonexposure to their use. Concerned professionals must be provided with this information and strict measures must be instituted to ensure patient security.