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Elissa Ladd, PhD, RN, FNP-BC ; Diane Mahoney, PhD, RN, GNP ; Sri Emani , PhD

“ UNDER THE RADAR”: NURSE PRESCRIBERS AND PHARMACEUTICAL INDUSTRY PROMOTIONS. Elissa Ladd, PhD, RN, FNP-BC ; Diane Mahoney, PhD, RN, GNP ; Sri Emani , PhD. Funding Source: US Attorneys General Consumer and Prescriber Grant Program*

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Elissa Ladd, PhD, RN, FNP-BC ; Diane Mahoney, PhD, RN, GNP ; Sri Emani , PhD

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  1. “UNDER THE RADAR”: NURSE PRESCRIBERS AND PHARMACEUTICAL INDUSTRY PROMOTIONS Elissa Ladd, PhD, RN, FNP-BC; Diane Mahoney, PhD, RN, GNP ;Sri Emani, PhD

  2. Funding Source: US Attorneys General Consumer and Prescriber Grant Program* * Resulted from a $430 million settlement that reconciled allegations of an unlawful marketing campaign for the drug Neurontin® that violated state consumer protection laws

  3. Background: APN Prescribing in the US • Advance Practice Nurse (APN) prescribers: nurse practitioners (NPs), certified nurse midwives (CNMs), mental health clinical nurse specialists, nurse anesthetists • > 150,000 NP APN prescribers (100,000 Family Physicians) – primary care • Statutory authority to prescribe in all 50 states (US) and the District of Columbia • 97% write prescriptions: 9 – 25/day; 6200Rx/NP/yr; 500 million prescriptions a year (Bacchetta & Green, 2007; Treise& Rausch, 2005)

  4. Pharmaceutical Industry Influence on Prescribing • Studies consistently show that promotion increases prescribing (Chren ,1994; Lurie,1990; Wazana,2000;Fischer,2009)) • Studies consistently show that both physicians and APN prescribers do not believe that promotion affects prescribing (Fisher et al., 2009; Crigger, et al., 2009) • NPs have an uncritically positive attitude toward pharmaceutical promotions (Fisher et al., 2009; Crigger, et al., 2009) • Paucity of empirical data on nurse prescribing behaviors in relation to pharmaceutical marketing

  5. METHODS:peRx: Prescribing Evidence Based Therapies • Web-based educational intervention on • pharmaceutical marketing, conflicts of • interest, and evidence-based prescribing • Produced in visually engaging entertaining format:

  6. Evaluation: Web-based surveys (2007-2008) • Baseline (n = 263) • Post 1 (n =208) - immediate • Post 2(n=189) – 8 weeks post intervention Three key domains: • Perceived reliability of information provided by industry • Acceptability of promotional items and meals • Self-reported prescribing practices.

  7. Selected Results: Baseline: • Nurse prescribers had broad interface with pharmaceutical industry promotions at baseline: • Representatives • Samples • Meal events • Continuing education

  8. Key Domains: PostIntervention

  9. Lessons Learned • Nurse prescribers (APNs) are clearly “flying under the radar” regarding research and programs that address: • Pharmaceutical industry interface with health care professionals • Programs re: Evidence base prescribing and use of generic medications • Broad interest from the academic community to integrate material into pre-professional and post-baccalaureate curricula (> 100 graduate programs)

  10. Policy Implications • Advance practice nurses (APNs) have the legal authority • to prescribe in seven western European and Anglo • Saxan countries; 4 other countries in the process of • introducing nurse prescribing*(HAI, 2011; Kroezen et • al.,2011) * Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA; The Netherlands and Spain pending regulatory approval; Finland: proposed Government approval; South Africa regulatory evaluation • Significant expansion of promotional activities that are • directed to nurse prescribers • Limited integration into programs that foster evidence • based prescribing, i.e. academic detailing, rational medicine use • education

  11. Nurses as Explicit and Implicit Prescribers • Explicit Prescribers: Formal or statutory authority to prescribe • Implicit Prescribers: Informal prescribers • Active participants in therapeutic choices of both prescribers and patients (medications and non-pharmacologic therapies) • 95% of nurses reported being asked by friends, family, or patients about prescription drugs (ANA, 2010) • Improve decision making for “as needed” medications in mental health care (Usher et al. 2009) • Instrumental in avoidance in errors and adverse events in prescribing (Plew-Ogan,et al., 2004)

  12. Nurses are the largest segment of the post-professional healthcare workforce worldwide (~ 17.6 million) (WHO,2010) • Task shifting • Compelling power to influence rational use of pharmacotherapeutics • Compelling potential to contribute to inter-professional strategies (research and programmatic models) for appropriate medicine use

  13. Thank you eladd@mghihp.edu

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