- Ugur Akinci, Ph.D., Nurse-Recruiter.com
It is an intricate situation... Most states or local administrative
regions do not have enough funds to check up and monitor all those who need
medical treatment, especially those suffering from chronic diseases like diabetes
So what if a pharmaceutical companies puts up the funds to
have qualified nurses visit doctors' offices to review the charts of the patients
and to assess their progress? They sometimes also provide much needed
professional development training for the office staff as well.
The practice, generally referred to as “disease-management programs,” started
in U.K. but is spreading to Ireland, Germany and Belgium as well. The French
drug maker Sanofi-Aventis SA, for example, is funding programs in Britain to
provide training materials and classes for the staff nurses working in doctors'
offices. However, the company officially claims that no attempt is made to
push any proprietary drugs.
Critics of the practice charge that such pharmaceutical company programs are nothing
but a thinly veiled attempt to push more highly-priced pills that the company
manufactures. Dr. Jim Kennedy, the spokesman for the Royal College of
General Practitioners, is reported in American press as saying that there
is a "perceived or real risk of the pharmaceutical companies' interests taking
precedence over the patients' interests.”
The conflict of interest perhaps cannot be proven with 100% certainty but
it's there and everyone knows it, the critics claim.
As proof, the point at what happened to Merck last year in Britain where
such paid-nurse visits are very prevalent. The Prescription Medicines Code
of Practice Authority, a British watchdog group, has examined the complaint
filed by a former Merck sales representative and decided that the program was
indeed a “reward program” for those doctors prescribing “Cozaar,” a Merck product.
After being suspended for three months, Merck wrote a letter to all doctors
involved and said it was taking the issue "very seriously," and that it "is working
hard on corrective actions."
Another issue that the critics of the program like Royal College of Nursing
bring up is the alleged violation of the patients' privacy when these “contract nurses”
examine the patient charts usually without the knowledge or the consent of the
patients involved. In a recent $80,000 program sponsored by several big drug
companies, for example, the nurses contracted from outside examined patient
records for six months to find out instances of heart disease.
The defenders of the program insist that the nurses are prohibited from sharing
such patient information with the pharmaceuticals and the abide by that rule.
The practice is not totally unknown in the United States. Pfizer Health Solutions
have sponsored similar “disease-management programs” in Florida, especially for
Medicaid and Medicare patients. Between 2001 and 2005, a group of Pfizer-paid
nurses visited tens of thousands of Florida patients with asthma, diabetes and heart
disease or talked to them over the phone. The “contract nurses” encouraged these
patients with chronic illness to eat well, consulted with them on how to exercise
properly and take their medications regularly.
As in all other cases, Pfizer claimed it was rendering the State of Florida
an important public health service by diagnosing chronic problems before
they evolved into much more serious and costly cases. Florida saved money
by allowing Pfizer to carry out such programs, the company officials claimed.
The Sunshine State, in return, seems to have agreed with that assessment since
it gave a “preferred status” to Pfizer drugs for its Medicaid patients.
So it's a delicate symbiotic situation in which the states and governments,
on the one hand, and the pharmaceutical companies, on the other, are trying
to come up with a middle-path solution in which one side would manage to
stem the ever-increasing cost of treating chronic diseases while the other
side is guaranteed an inelastic demand for its prescription drugs. Caught
in between are our professional nurses who have to rely more on their innate
sense of right and wrong and their oath “not to do any harm” than anything else.
Given the trend in rising medical care costs and tight state budgets, I think
we will see more cases of similar “disease-management programs” in the
United States and more opportunities for RNs to offer their services through
quality professional agencies like those found on Nurse-Recruiter.