Of the 84 identified locations, drug samples were found in 21 locations, all intended for ambulatory patients (i.e., outpatient clinics and day centres). No drug samples were found in inpatient care units.
Overall, the number of doses of drug samples (n = 78 955 doses) was 2.4 times greater than the number of doses of drug floor stock (n = 32 987 doses) (Table 1). The outpatient clinics with the largest stocks of drug samples were (in decreasing order) pneumology, obstetrics and gynecology, pediatrics, dermatology, and otorhinolaryngology, and these clinics accounted for 80% of the sample doses. The distribution of drug floor stock among the various clinics differed from that for the drug samples (Table 1).
At least 1 person was identified as being in charge of managing drug samples in 11 of the 21 locations. A total of 13 different types of storage areas were identified: examination rooms (n = 7), nurses’ offices (n = 5), nursing stations (n = 4), doctors’ rooms or offices (n = 3), rooms for measuring patients’ weight and height (n = 2), reception areas (n = 2), storerooms (n = 2), floor pharmacy (n = 1), photocopy room (n = 1), common work room (n = 1), test room (n = 1), corridor (n = 1), and recovery room (n = 1). Fourteen of these 31 storage areas did not have a lock. Six types of storage were identified: cabinet (n = 20), office area (n = 3), drawer (n = 3), storage shelf (n = 3), pantry (n = 1), and refrigerator (n = 1).
According to interviews with the contact person at each location, the reasons for handing out samples included (in decreasing order) avoiding costs for the patients (n = 8), trying a treatment (n = 7), starting a treatment (n = 5), facilitating a treatment (n = 4), alleviating pain or fever (n = 4), providing patient education (n = 3), treating health care staff (n = 3), deciding between 2 treatments (n = 1), evaluating side effects (n = 1), providing a quantity of medication sufficient to last until the next planned prescription renewal (n = 1), responding to a relative’s request (n = 1), and using the sample simply because it was available (n = 1). cialis professional
Table 1. Comparative Profile of Drug Samples and Drug Floor Stock by Location
The drug samples were classified in 23 therapeutic classes (Table 2) and came from 62 different pharmaceutical companies. The companies represented by the greatest number of samples were Wyeth Ayerst (25 different products), Stiefel (17), Sanofi-Aventis (10), Novo Nordisk (10), Eli Lilly (10), and Glaxo-Smith Kline (10). The companies represented by the greatest number of distribution units and number of therapeutic classes were Wyeth Ayerst (28.5% of distribution units, in 6 therapeutic classes), Stiefel (7.4% of distribution units, in 1 therapeutic class), Merck Frosst (5.3% of distribution units, in 2 therapeutic classes), Galderma (4.7% of distribution units, in 1 therapeutic class), Johnson & Johnson (3.3% of distribution units, in 4 therapeutic classes), and Baush & Lomb (3.3% of distribution units in 2 therapeutic classes). canadian antibiotics
A comparison of inventoried stock with declarations archived in the pharmacy revealed that only 3.5% (n = 302) of the drug sample distribution units had been declared to the pharmacy department according to established policy. Generally speaking, the samples were given to physicians, nurses, or clerks or were dropped off by pharmaceutical sales representatives in locations where samples were already present, or they were sent by regular mail, sometimes at the request of hospital staff.
Table 2. Comparative Profiles of Drug Samples and Drug Floor Stock by Therapeutic Class
A total of 159 generic entities and 266 different brands were counted. In decreasing order, by proportion of distribution units of the generic entity, the most important drugs were ibuprofen (15.4% of all distribution units), multivitamins (8.1%), dorzolamide/timolol (4.1%), fluorescein (3.2%), adapalene (2.4%), metronidazole for topical administration (2.4%), hydroquinone (2.0%), cetirizine (1.9%), tretinoin (1.9%), and calcium-vitamin D (1.9%). In monetary terms, the total value of the sample distribution units, including expired units, was Can$48 783, based on the unit prices in effect in October 2007. In comparison, the value of authorized drugs in the clinics’ stock was Can$21 813.
Of the identified stock, the inventory showed that 732 (8.3%) of the distribution units were expired; the most common expired drugs were anti-infective agents, enzymes, gastro-intestinal medications and sera, antitoxins, and vaccines. Furthermore, 5226 (59%) of the drug sample distribution units identified during the inventory were not on the hospital’s local formulary, as approved by the Pharmacology and Therapeutics Committee.