Despite regulations governing the pharmaceutical industry, the push from large companies to prescribe brand-name medications is undeniably present.  Gourmet dinner meetings and free lunches delivered to hospital and clinic staff entice providers to write scripts for expensive medications.  Although most patients would understandably prefer prescriptions for generic drugs, physicians, PA’s and NP’s often endorse brand-name medications.  Why?

New research out of the University of Pennsylvania has identified an important factor influencing  prescribing habits.  Researchers monitored the antidepressant prescribing patterns of psychiatrists who completed residency in 162 different programs.  Antidepressant use among Americans increased 400 percent from 1988 to 2008.  Brand-name antidepressant medications are heavily marketed to consumers and the medical community although plenty of generic alternatives exist.  The goal of the study was to determine if a residency’s conflict-of-interest policies, regulations regarding medical resident’s level of contact with the pharmaceutical industry, influenced physicians to prescribe brand name antidepressant medications over generic alternatives.

Results of the study show that rates of prescribing band name medications were higher for residents that graduated in 2001 before pharmaceutical regulations were implemented than for 2008 graduates.  Furthermore, 2008 graduates attending residency programs with more restrictive conflict-of-interest policies wrote fewer prescriptions for brand-name antidepressant medications.

Although this study focused on prescribing patterns of physicians, statistics among nurse practitioners are likely similar.  We naturally practice similarly to those who train us.  If our clinical preceptors welcome pharmaceutical reps into their clinics and prescribe large numbers of expensive medications, as nurse practitioners we learn to do the same.

Conflict-of-interest policies in nurse practitioner programs should be implemented as they will help NP’s learn to practice in the most cost effective manner.  Yes, it is important for students to keep up to date with advances in the pharmaceutical industry, however focusing on cost-effective care particularly by advocating use of generic medications is in the best interest of the nurse practitioner student and future patients.


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