There’s growing awareness that payments by the pharmaceutical industry to doctors – including the provision of even a modest meal at company-hosted events – are associated with poorer quality prescribing behaviour and increased healthcare costs. Yet they remain commonplace, even as transparency around such payments is in decline in Australia.
Less well understood is how pharmaceutical companies engage with other, non-prescribing healthcare professionals that also play a vital role in patient care, medication management and healthcare administration – and what influence that might have.
Published in a JAMA Internal Medicine research letter today, new analysis provides a unique insight into the nature and extent of payments to non-prescribing healthcare professionals such as nurses, pharmacists, physiotherapists, psychologists, dietitians and more.
“There is a mistaken idea that non-prescribing healthcare professionals don’t have much influence on medicine use, therefore their pharmaceutical industry ties aren’t that important,” said lead author Dr Emily Karanges from the University of Sydney’s Evidence, Policy and Influence Collaborative at the Charles Perkins Centre and School of Pharmacy.
“Yet healthcare professionals like nurses and pharmacists often assist with medication choice and encourage adherence to treatment – and the roles they play in chronic disease management are expanding too.”
The research team, from the University of Sydney and University of Toronto, analysed payments to Australian healthcare professionals using publicly available reports submitted to regulator Medicines Australia by their member companies.
We found the most highly paid healthcare professionals were often working in hospitals in chronic disease management, and chronic diseases such as HIV and multiple sclerosis have expensive treatments that are required long-term.
The data do not include all pharmaceutical companies, research-related payments or product details associated with payments, however the analysis provides the first comprehensive account of payments to non-physicians.
Between October 2015 and April 2018, 14,018 healthcare professionals were found to have received $62,695,095 in pharmaceutical industry payments.
While most payments were to doctors, other healthcare professionals accounted for 22.1 percent of recipients and 16.1 percent of payments yet received just 10 percent of total spend. Nurses and pharmacists were the primary recipients after doctors: nurses accounted for 17.8 percent of recipients but received 8.3 percent of expenditure, and pharmacists accounted for 2.9 percent of recipients and received 1 percent of total spend.
The top contributing companies included: Biogen, a manufacturer of products for conditions including multiple sclerosis; Gilead, with an expanding market in HIV and hepatitis medicines; and Shire, whose products include drugs for attention-deficit hyperactivity disorder and binge eating disorder.
Payments were reported to support activity such as attendance at meetings and speaker and advisory board engagements, as well as associated travel and accommodation costs.
“For the benefit of patients, and to protect and maintain the integrity of our valued healthcare providers, we need better oversight, understanding and education of the potential impacts of such activity,” Dr Karanges said.
Co-author Professor Lisa Bero from the University of Sydney's Charles Perkins Centre and School of Pharmacy said the findings had global implications.
“These data are unique,” said Professor Bero.
“Pharmaceutical companies are clearly courting non-prescribing healthcare professionals as well as doctors in Australia, presumably because of the increasingly important role and influence they have in clinical care.
“Inevitably this type of activity and potential influence is happening around the world, but pharmaceutical influence on non-prescribers remains hidden because the data are simply not available in other countries.
“There is an urgent and global need to extend mandatory transparency reporting and institutional policies that apply to all healthcare professionals.”
Disclosures: Co-author Dr Grundy reported receiving grants from the Canadian Institutes of Health Research during the conduct of the study. No other disclosures were reported.