Pharmaceutical companies are increasingly targeting nurses when it comes to industry-sponsored events.
Although nurse-only events are still uncommon (5% of all events), nearly twice as many pharma-sponsored events in Australia now have nurses present than have GPs.
Research by the University of Sydney, published in JAMA Internal Medicine today, examined four years of industry-sponsored events to 2015. A total of 116,485 events were reported by pharmaceutical companies who were members of Medicines Australia.
Nurses were present at 40% of all events, GPs at 21%, while specialist physicians came in top, at 69%.
Of events aimed at a single profession, 5% included only nurses, 9% only GPs, and 18% only specialists.
Nurse-only events were decidedly cheaper for the sponsors: The per-person cost was only 39% of the amount spent at doctor-only events. Events where nurses were present were significantly less likely to include a served dinner, or to be held overseas.
So, why is money being spent on nurses, at two in five events?
For an industry whose profits come from prescription turnover, at first glance it seems odd to target a profession that doesn’t prescribe. The exception would be nurse practitioners, but in Australia they account for only 0.005% of all nurses, and were present at less than 1% of these events.
I suspect the industry is aware that nurses have more sway over prescription choices than most doctors suppose. This is particularly so in hospitals, which employ the majority of Australia’s 271,000 nurses.
Quite appropriately, nurses are present at many of the decision-making points in hospitals; from large-scale purchasing orders, to operating theatres (where medical device company reps play an important marketing role), to educating individual patients about pills, puffers and injections.
However, primary health care also involves plenty of drugs that are nurse-influenced, even if not nurse-prescribed. The education of diabetes and asthma nurses is an increasingly valuable area of influence for pharmaceutical and device companies, who sponsor everything from the events to the educators, as well as the overarching bodies who oversee those areas.
Hepatitis is a recent example of where a nurse sub-specialist may know more detail than an occasional GP prescriber, so the industry may see substantial return on their investment. Wound care educational events, where promoted products can cost many times more than traditional products, have long been popular among sponsors.
Although recent focus has been around the transparency of doctors and pharmaceutical payments, perhaps similar scrutiny should apply to nurses; particularly those who influence significant purchasing and educational decisions. Transparency doesn’t resolve conflict-of-interest issues, but at least it gives them a good airing.
As the authors suggest in JAMA, “the high prevalence of nurses’ attendance suggests that transparency regulation and conflict of interest management should routinely include nurses and other health professionals.”
While I’m not disagreeing with your conclusions and rationale, I can think of several additional/alternative reasons why pharma companies are opening their educational event doors to nurses. I have facilitated many a medical education session aimed at doctors but opened to other members of the health care team such as practice managers and nurses. I hasten to add that none of these had anything to do with pharma but instead were around GP training, medico-legal issues and things like the Collaboratives (NPCC) program. As a general rule, I’ve found non-doctor participants are:
1) More likely to register
2) More likely to turn up if registered
3) More likely to turn up on time
4) Far more positive about the session and grateful to have been included
5) Less likely to complain about the catering/ venue.
6) Attentive, engaged and generally good participants
7) More likely to complete feedback forms, and give considered and thoughtful feedback
In addition, having the different groups together are great team-building opportunities. The different perspectives can improve empathy and appreciation of others’ skill set and work challenges.
The opportunities for doctors to bring their spouse along (if the spouse is nurse or practice manager and I’m not being sexist – talking about both male and female doctors here) can increase the rate of doctor attendance.
If events are poorly attended, it can reflect poorly on the organisers, the presenters and sometimes even on the participants.
When those who work for pharma companies have KPIs which include the number of attendees at educational events and the written feedback from such events, opening the sessions up to nurses is a clever strategic move, regardless of perceived potential influence on prescribing.
Why would you not want keen, reliable, grateful participants who will help improve your KPIs?
Thanks Genevieve – an interesting perspective. I agree that this is likely to be one factor affecting those numbers.