In this study, 59% of the drug sample distribution units inventoried were not on Sainte-Justine local formulary. In the study by Haxby and others, 29% of drug samples given to patients were not on the hospital’s official list. A hospital’s drug formulary is established to ensure optimal drug use and patient safety. In the authors’ hospital, the drug list includes about 3000 products out of the approximately 26 000 available on the Canadian market. Drugs are listed on the formulary if they have good intrinsic efficacy and safety data, are adequately labelled, and fulfill local patient needs. It is clear that a manufacturer’s decision to offer drug samples is dictated by the emergence of new drugs and the search for a market share, rather than the needs of patients or health care professionals.
Given that the industry does not provide samples for drugs that have been on the market many years, we believe that the presence of samples is related to the pharmaceutical industry’s marketing activities, aimed at creating a “need” for new medications and influencing physicians to try recently marketed drugs. New drugs are often more expensive than older drugs, and hospital costs represent a small proportion of societal drug costs for any drug that may be used on a long-term, ambulatory basis. Beyond the fact that a majority of the samples identified were not on the hospital’s formulary, this study did not allow for an accounting of the additional societal costs related to use of the drugs on an ambulatory basis. Further studies are required to evaluate the factors that bring nonformulary drug samples into hospitals and the potential societal costs associated with the use of drug samples.
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Although stocks of drug samples were more common in certain areas of the institution, most outpatient clinics seemed to be targeted and visited by pharmaceutical representatives, who came with the intention of handing out drug samples. In 2004 the institution adopted a strict policy governing the use of drug samples in health care units but still allowing their distribution to outpatient clinics. Despite this policy, only 3.5% of the stock inventoried in this study had been declared to the pharmacy department according to existing procedures. Although less-than-perfect compliance with administrative policies would not be surprising, this very low level of compliance illustrates how difficult it is to monitor the activity of pharmaceutical sale representatives in a large institution. Not only are many sales representatives present in hospitals every day, but the representatives for each company change regularly because of reorganizations and shifts in activities. With no single policy in place throughout the health care system to manage (or proscribe) the distribution of drug samples, such changes in personnel contribute to the confusion and lack of compliance with hospital-based policies for pharmaceutical sale representatives. Also, outpatient clinics are similar to private clinics in that physicians, nurses, and clerks may function according to a local standard, rather than an institutional policy. Some nurses and physicians contacted during the inventory rounds for this study admitted that they thought the
hospital should not regulate the use of drug samples in clinics.