Efforts began by the clinic documenting the frequency of pharmaceutical reps, detailers, and pharma-funded lunches. Then, the clinic recorded the market-value of the free samples provided by companies and the cost of equivalent generics and less expensive, but equally as effective, medications. Interviews were also conducted, which asked clinic doctors and staff the value of pharma involvement in the clinic, whether there were any benefits of such involvement, and if the staff believed they would experience losses if the clinic were to become pharma-free. The clinic's staff were concerned about four main areas: "(1) the practice culture of seeing detailers, (2) the effect they had on staff morale, (3) sample expectations of patients and physicians, and (4) being current on new drugs" (p. 334). Additionally, the staff enjoyed pharma gifts and promotional items, personally used the free samples provided by reps, and enjoyed boosted morale from social gatherings during free lunches provided by pharma companies. The results from these interviews were used to inform clinic policy reform to restrict pharmaceutical reps, detailers, and free samples.
Policy reform occurred in the following areas:
- Physicians and staff in the clinic were required to educate themselves on the appropriate literature on conflicts of interest and the influence of physician-industry relationships on the medical practice.
- Monthly morning clinic meetings were to consist of presentations regarding the literature on the effects of pharmaceutical detailing, drug reps, and free samples on physicians' prescribing practices, patterns, safety, drug costs, and the ethics of accepting gifts from industry.
- To replace the pharma-funded free lunches, the practice instituted protected monthly all-clinic lunches, during which time all clinic staff could have social lunches together. (Lunches cost between $60 and $80.)
- Pharma-branded office supplies were replaced with non-industry supplies. (The cost of office supplies was less than $200.)
- Industry sources of drug information were replaced with non-industry, independent, reliable sources of drug information. The clinic provided its doctors and staff with monthly educational meetings in which doctors could discuss the merits of both new and old medications.
- Pharma-funded and provided pamphlets made available to patients were replaced by educational materials that explained the transition being experienced by the clinic. Patients supported this clinic's policy reform.
Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation