The effect of medication samples on self-reported prescribing practices: a statewide, cross-sectional survey.

BACKGROUND: The pharmaceutical industry spends billions of dollars annually to encourage clinicians to prescribe their medications. Small studies have demonstrated that one of the marketing strategies, the distribution of free sample medications, is associated with increased use of brand name medication over generic medication. OBJECTIVES: To determine the relationship between the presence of drug samples in primary care clinics and prescription of preferred drug treatments. DESIGN: Cross-sectional survey. PARTICIPANTS: Primary care prescribers in the state of Vermont. MAIN MEASUREMENT: Prescribers were presented with two clinical vignettes and asked to provide the name of the medication they would prescribe in each case. We compared the responses of prescribers with and without samples in their clinics. KEY RESULTS: Two hundred six prescribers out of the total population of 631 returned the survey and met the eligibility criteria. Seventy-two percent of prescribers had sample closets in their clinics. Seventy percent of clinicians with samples would prescribe a thiazide diuretic for hypertension compared to 91% in those without samples (P<0.01). For managing depression 91% of prescribers with samples would have provided a generic medication in a patient with no health insurance, compared to 100% of those without samples in their clinic (P=0.02). CONCLUSIONS: Clinicians with samples in their clinics were less likely to prescribe preferred medications for hypertension and depression.

The use of adherence aids by adults with diabetes: a cross-sectional survey.

BACKGROUND: Adherence with medication taking is a major barrier to physiologic control in diabetes and many strategies for improving adherence are in use. We sought to describe the use of mnemonic devices and other adherence aids by adults with diabetes and to investigate their association with control of hyperglycemia, hyperlipidemia and hypertension. METHODS: Cross sectional survey of diabetic adults randomly selected from Primary Care practices in the Vermont Diabetes Information System. We used linear regression to examine the associations between the use of various aids and physiologic control among subjects who used oral agents for hyperglycemia, hypercholesterolemia, and hypertension. RESULTS: 289 subjects (mean age 65.4 years; 51% female) used medications for all three conditions. Adherence aids were reported by 80%. The most popular were day-of-the-week pill boxes (50%), putting the pills in a special place (41%), and associating pill taking with a daily event such as a meal, TV show, or bedtime (11%). After adjusting for age, sex, marital status, income, and education, those who used a special place had better glycemic control (A1C -0.36%; P = .04) and systolic blood pressure (-5.9 mm Hg; P = .05) than those who used no aids. Those who used a daily event had better A1C (-0.56%; P = .01) than patients who used no aids. CONCLUSION: Although adherence aids are in common use among adults with diabetes, there is little evidence that they are efficacious. In this study, we found a few statistically significant associations with adherence aids and better diabetes control. However, these findings could be attributed to multiple comparisons or unmeasured confounders. Until more rigorous evaluations are available, it seems reasonable to recommend keeping medicines in a special place for diabetic adults prescribed multiple medications.

Measuring the nursing workforce: clarifying the definitions.

Numerous articles have addressed the causes and implications of the current nursing shortage. Little has been published, however, about how to measure the nursing workforce. This article presents (1) a review of definitions for common workforce indicators such as vacancy and turnoverrates and the relationship between these indicators and the need for nurses,(2) a review of the calculation of vacancy and turnoverrates in several statewide and national surveys, and (3) the results from the development and pilot test of a health care workforce survey for use in Vermont. The review indicates that in practice, no standard method is used despite attempts to standardize the calculation of vacancy and turnover rates. The Vermont pilot study results demonstrate that a richer profile of the health workforce can be obtained by using both standard workforce measures and more subjective questions to assess a statewide need for nurses.