Pharmaceutical Detailing

Soumerai and Avorn [11] studied the success of pharmaceutical manufacturers in influencing prescribing behavior and reported their findings as academic detailing. During the past 30 years of discussions with pharmaceutical representatives located throughout the United States, I have identified a consistent pattern of supplementary techniques that also appear to be consistently effective.

Combining these sources of information, I'm convinced that influencing a single physician to change his or her prescribing patterns can be successfully accomplished through the following steps:

1. First and foremost is the establishment of a personal relationship with a physician. This usually begins with a soft and low-key introduction of oneself, which is intended to establish credibility and respect as a knowledgeable professional.

2. Identification of the baseline knowledge and motivations that underlie the physician's existing prescribing practices.

3. Introduction of the single message targeted for inclusion into the physician's practice. The message should be kept simple and have a clear behavioral objective.

4. Engagement of the physician in an interactive discussion process. Concise graphic educational material may be helpful, but providing samples of the new medication allows a physician to become hands-on familiar both with its dosing and patient acceptance.

5. Subsequent and repeated contacts are essential both to create a firm personal relationship and to support a lasting change in prescribing behavior. During these subsequent encounters, the initial message should be consistently repeated. Hard sell is to be avoided. Maintaining respect for the physician's knowledge and position diminishes barriers to the progressive introduction of new scientific data that further supports the message.

6. The program should initially be focused on respected local physician leaders. The introductory message should be accompanied by information designed to reduce fears related to being the first, because physicians know that new medications may subsequently be found to cause unexpected and serious side effects.

7. Both sides of a controversial issue must always be presented. Reference to the guidelines of respected, unbiased national professional organizations can be very helpful once a physician's interest is attained.

8. After 4 to 6 visits, during which the initial message is consistently repeated, the message can be expanded.

For a pharmaceutical representative, the highest level of success is achieved when it becomes apparent that the representative has earned the respect of the physician and is considered by that physician to be a trusted advisor who will always tell the truth. I've had many pharmaceutical representatives relate, with obvious pride, both the date and the location of the time when one of "their" physicians called them for advice on the treatment of a patient.

The effectiveness of advertisements in journals is frequently challenged, but they can serve to capture a physician's interest in learning more about a medication. Moreover, once a product has been introduced to a physician, the ads serve as quick reference for proper dosing and side effects and afterwards support the physician's familiarity and comfort with the product.

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