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Association between gifts from pharmaceutical companies to French general practitioners and their drug prescribing patterns in 2016: retrospective study using the French Transparency in Healthcare and National Health Data System databases

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6015 (Published 06 November 2019) Cite this as: BMJ 2019;367:l6015

Commercial influence in health: from transparency to independence

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Linked Editorial

Declaring interests and restoring trust in medicine

  1. Bruno Goupil, general practitioner1,
  2. Frédéric Balusson, data manager and statistician2,
  3. Florian Naudet, professor of therapeutics and psychiatrist34,
  4. Maxime Esvan, statistician3,
  5. Benjamin Bastian, senior registrar and general practitioner13,
  6. Anthony Chapron, senior lecturer and general practitioner13,
  7. Pierre Frouard, senior lecturer and general practitioner1
  1. 1Department of General Medicine, University of Rennes 1, Rennes, France
  2. 2EA 7449 (Pharmaco-epidemiology and Health Services Research) REPERES, Univ Rennes, Rennes University Hospital, Rennes, France
  3. 3Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), F-35000 Rennes, France
  4. 4Department of Adult Psychiatry, Rennes University Hospital, Rennes, France
  1. Correspondence to: P Frouard pierre.frouard{at}gmail.com
  • Accepted 9 October 2019

Abstract

Objective To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns.

Design Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare).

Setting Primary care, France.

Participants 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database.

Main outcome measures The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses.

Results The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (−€5.33 (99.9% confidence interval −€6.99 to −€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (−0.68%, −1.13% to −0.23% compared with the €240-€999 group) and vasodilators (−0.15%, −0.28% to −0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors.

Conclusion The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded.

Trial registration OSF register OSF.IO/8M3QR.

Footnotes

  • Contributors: BG and PF initiated and designed the study, searched the literature, interpreted the results, and wrote the manuscript. FB performed the analysis and interpreted results. FN and ME contributed to the study design and interpreted the results. BB contributed to the study design. AC contributed to the study design and offered institutional support. PF is guarantor. All authors have critically revised the manuscript for important intellectual content and approved the manuscript. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: None.

  • Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; AC reports personal fees and non-financial support from Roche, personal fees and non-financial support from Novartis Pharma, and personal fees from Congrès colloques conventions, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the French Commission Nationale Informatique et Libertés (authorisation CNIL DR 2018-089). A letter has been delivered to all French URPS (Unions Régionales des Professionnels de Santé) to inform general practitioners of the objective of the research and give them the right to oppose.

  • Data sharing: Data from Transparency in Healthcare database are available on www.data.gouv.fr. We cannot share National Health Data System data as they are only available on a secure portal. Authorisation to access this portal needs registration and clearance.

  • The guarantor (PF) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspect of the study was omitted; and that any discrepancies from the study as originally planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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