Pharmaceutical company influence on nonsteroidal anti-inflammatory drug prescribing behaviors.

OBJECTIVES: To describe the taxonomy of methods used by pharmaceutical companies to influence physicians' nonsteroidal anti-inflammatory drug (NSAID) prescribing behaviors and to elicit physicians' perceptions of and counterbalances to these influences. STUDY DESIGN: In-depth interviews analyzed using the constant comparative method of qualitative data analysis. METHODS: Qualitative interviews were conducted with physicians representing various clinical specialties. Interviews were transcribed and coded inductively using grounded theory. Recruitment was stopped at 25 participants after the attainment of thematic saturation, when no new concepts emerged from ongoing analysis of consecutive interviews. RESULTS: Physicians described a variety of influences that shaped their NSAID prescribing behaviors, including detailing and direct contact with pharmaceutical representatives, requests from patients inspired by direct-to-consumer advertisements, and marketing during medical school and residency training. Physicians described practice guidelines, peer-reviewed evidence, and opinions of local physician experts as important counterweights to pharmaceutical company influence. Local physician experts interpreted and provided context for new clinical evidence, practice guidelines, and NSAID-related marketing. CONCLUSIONS: The social and communicative strategies used by pharmaceutical companies can be adapted to improve physicians' adoption of guidelines for safer NSAID prescribing. Communicative interactions between local experts and other physicians who prescribe NSAIDs may be the critical target for future interventions to promote safer NSAID prescribing.