The Inclusion of Nurses in Pharmaceutical Industry–Sponsored Events: Guess Who Is Also Coming to Dinner?

The release of the Open Payments data in the United States, which detail payments from pharmaceutical and medical device companies to physicians, enables analysis of the financial relationships between physicians and industry.¹ However, the Physician Payments Sunshine Act, which mandates these disclosures, omits registered nurses. A recent qualitative study suggests nurse-industry interactions in US hospitals may be common and influential.² The limited prevalence data available, based on self-report, suggests that 51% to 96% of nurses have contact with industry representatives.³

Australia is one of the few jurisdictions to report payments to all registered health professionals. Since 2007, member companies of the industry trade association, Medicines Australia, have voluntarily reported sponsorship of functions for health professionals.⁴ This report describes the extent of inclusion of nurses in pharmaceutical company-sponsored events in Australia. In 2016, there were 271 423 practicing registered nurses in Australia. Of these, 1380 (0.005%) were nurse practitioners, which is the category of registered nurse permitted to prescribe medicines.⁵

We downloaded all available reports of sponsored events for health professionals from the Medicines Australia website. The reports covered 6-month intervals from October 2011 to September 2015 (n = 301 reports) and detailed 116 845 events. We converted the PDF reports to Excel format and coded the unstructured data using iteratively generated keywords and Excel’s filter function. We focused analysis on a subset of events (71% [81 946]) to compare events with nurses in attendance and physician-only events. We excluded events without nurses or physicians, physician-only events with trainees, and those missing data on professional status of attendees. We used SPSS statistical software (version 22) to conduct descriptive analyses, Kruskal-Wallis tests for the differences among medians and χ² tests for differences among proportions. Significance of post hoc comparisons was evaluated using a Bonferroni correction.

Nurses were present at 39.6% of all events (46 214 of 116 845 events), nearly twice as often as primary care physicians (21.1% [24 662 of 116 845). Physician specialists were present at most events (68.5% [80 060 of 116 845]). Over 40% of events (47 084 of 116 845) included attendees from multiple professions, whereas 4.8% (5645 of 116 845) included only nurses, 9.1% (10 647 of 116 845) only primary care physicians, and 17.7% (20 692 of 116 845) only specialists. Nurse practitioners in Australia have prescribing authority: they were present at less than 1% of events (1013 of 116 845).

The Table details characteristics of nurse-attended events compared with physician-only events (with costs given in Australian dollars) (71% [81 946]). The median cost per event with nurses-only ($176; interquartile range [IQR], $44-$932) was significantly less than multidisciplinary events with at least 1 nurse present ($250; IQR, $163-$694) (P < .001). The median cost per event was significantly greater for events with physicians-only ($482; IQR, $167-$2330) compared with multidisciplinary events (P < .001). Events with nurses only were significantly more likely to be scientific meetings or in-services than multidisciplinary or physician-only events (P < .001). Events held overseas or where dinner was served were significantly more likely to be physician-only than multidisciplinary or nurse-only (P < .001).

Whereas most transparency regulation focuses on physicians, the pharmaceutical industry targets a broader range of health professions in sponsored events. Thirty-five percent of all events included nurses in addition to colleagues from a range of disciplines, suggesting that this type of marketing targets health care teams. However, nurses were also specifically targeted, and a small proportion of events included nurses only. Although a small proportion of nurse attendees had prescribing authority, nonprescribing nurses may have been routinely included in pharmaceutical industry-sponsored events, which perhaps reflects their role in medication compliance, the management of chronic disease, and hospital purchasing.⁶ Although we could not verify the accuracy of the reports and our analysis was limited by the available data, to our knowledge, this is the first measure of prevalence of nurses’ attendance at pharmaceutical industry-sponsored events. The high prevalence of nurses’ attendance suggests that transparency regulation and conflict of interest management should routinely include nurses and other health professionals.

Corresponding Author: Quinn Grundy, PhD, RN, Faculty of Pharmacy and Charles Perkins Centre, The University of Sydney, D17, Sixth Floor, The Hub, NSW, 2006, Australia (quinn.grundy@sydney.edu.au).

Published Online: September 12, 2016. doi:10.1001/jamainternmed.2016.5276

Author Contributions: Dr Grundy had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Grundy, Mintzes, Bero.

Acquisition, analysis, or interpretation of data: Grundy, Fabbri, Mintzes, Swandari.

Drafting of the manuscript: Grundy.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Grundy, Swandari.

Obtained funding: Mintzes.

Administrative, technical, or material support: Mintzes, Swandari.

Study supervision: Grundy, Mintzes, Bero.

No additional contributions: Fabbri.

Conflict of Interest Disclosures: None reported.

Funding/Support: The work was partially funded via a University of Sydney Faculty of Pharmacy summer scholarship.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Ray Moynihan, PhD (Bond University), for access to the data and project guidance and Joanne Gale, PhD (University of Sydney), for guidance on statistical methods. Neither Dr Moynihan nor Dr Gale were compensated for this support.