Abstract:Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self… Show more
“…15 Doctors' relationships with pharmaceutical representatives appear to influence prescribing practices 16,17 , and concerns exist related to gift-giving ethics. 18,19 Recent lay publications have also raised ethical questions about some doctors' relationships with the pharmaceutical industry. [20][21][22] Participants in our study described trust as important in accepting a doctor's recommendation for a medication.…”
BACKGROUND: An estimated 20-50% of patients do not take medications as recommended. Accepting a doctor's recommendation is the first step in medication adherence, yet little is known about patients' beliefs and preferences about how medications are prescribed.
OBJECTIVE:To explore patients' beliefs and preferences about medication prescribing to understand factors that might affect medication adherence.
METHODS:Fifty members from 2 health plans in Massachusetts participated in in-depth telephone interviews. Participants listened to an audio-vignette of a doctor prescribing a medication to a patient and were asked a series of questions related to the vignette. Responses were reviewed in an iterative process to identify themes related to participants' beliefs and preferences about medication prescribing.
RESULTS:Participants' beliefs and preferences about medication prescribing encompassed 3 major areas: patient-doctor relationships, outside influences, and professional expertise. Important findings included participants' concerns about the pharmaceutical industry's influence on doctors' prescribing practices and beliefs that there is a clear "best" medication for most health problems.
CONCLUSIONS:Patients' beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors' relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.
“…15 Doctors' relationships with pharmaceutical representatives appear to influence prescribing practices 16,17 , and concerns exist related to gift-giving ethics. 18,19 Recent lay publications have also raised ethical questions about some doctors' relationships with the pharmaceutical industry. [20][21][22] Participants in our study described trust as important in accepting a doctor's recommendation for a medication.…”
BACKGROUND: An estimated 20-50% of patients do not take medications as recommended. Accepting a doctor's recommendation is the first step in medication adherence, yet little is known about patients' beliefs and preferences about how medications are prescribed.
OBJECTIVE:To explore patients' beliefs and preferences about medication prescribing to understand factors that might affect medication adherence.
METHODS:Fifty members from 2 health plans in Massachusetts participated in in-depth telephone interviews. Participants listened to an audio-vignette of a doctor prescribing a medication to a patient and were asked a series of questions related to the vignette. Responses were reviewed in an iterative process to identify themes related to participants' beliefs and preferences about medication prescribing.
RESULTS:Participants' beliefs and preferences about medication prescribing encompassed 3 major areas: patient-doctor relationships, outside influences, and professional expertise. Important findings included participants' concerns about the pharmaceutical industry's influence on doctors' prescribing practices and beliefs that there is a clear "best" medication for most health problems.
CONCLUSIONS:Patients' beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors' relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.
“…1 While professionalism is hard to objectively measure and difficult to teach, there has been progress in areas like patient confidentiality (e.g., the Health Insurance Portability and Accountability Act), communication skills, interactions with pharmaceutical companies, law and ethics. [2][3][4][5][6][7][8][9][10][11][12] However, despite extensive research and debate, it remains difficult to define or measure the domain that the ACGME calls the "professional accountability to society." 1,10,[13][14][15][16] Further, in this age of Internet communication, the identity of being a 'professional" is expanding, inadvertently blurring the interface between work and personal time.…”
“…Making use of innovative solutions for addressing the conflicts of interest that flow from industry-HCP relationships is an ethical requirement to avoid harm to patients and to help improve the quality of pharmaceutical education. Strategies have been described for eliminating industry influence in practice at both large academic medical centers and family practice settings [22], sometimes termed being "pharma-free" [21]. With the advent of the patientcentered medical home, other options may begin to make more cultural sense, such as increasing utilization of the only medication experts in health care-pharmacists-in novel ways.…”
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