1. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE The following presentation contains some items that are covered by copyright and are used under Fair Use for education and the federally legislated TEACH Act. Any use for other purposes must follow U.S. copyright rules. The contents of this module are accurate at the time of publication.

2. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 1. I sometimes feel manipulated by pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree 2. I usually feel that I am in control when interacting with pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree Questions

3. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 3. I wish I could be more assertive in my dealings with pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree 4. I know how to get the information that I need from a pharmaceutical representative. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree Questions

4. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE

5. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hello Dr. Smith, I’m Constance Ramos with GBU Pharmaceuticals. I’d like to talk with you for a couple of minutes about our new therapeutic agent GUDAZNU, if you could spare the time. I know that your patient population would benefit tremendously from this treatment.” 5. How might you respond to this pharm rep? Please enter your answer below. Questions

6. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE

7. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hi Dr. Smith, Constance Ramos from GBU Pharmaceuticals. I’ve just come from your spine clinic where I was talking with Dr. Bakki about GUDAZNU for pain control. He is recommending it for many of his patients. I wonder if you have a minute to talk with me about how it might help in your own practice?” 6. How might you respond to this pharm rep? Please enter your answer below. Questions

8. Provider – Pharmaceutical Representative (PR) Communication

9. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Objectives Understand why prescribers need to manage pharmaceutical rep interactions Identify challenging elements in these interactions Empower prescribers to control these interactions Use the 5-minute pharmaceutical representative interaction model

10. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Provider-Pharm Rep Interaction

11. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Does this sound familiar to you?

12. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Perceived influence of pharm reps on prescribing practices Steinman MA, et al. Am J Med. 2001;110(7):551-557.

13. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Percent of respondents who agreed the following gifts were inappropriate Gibbons RV, et al. J Gen Intern Med. 1998;13(3):151-154.

14. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Do you think accepting gifts might influence your patient relationships? (Please enter your answer below)

15. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE How about this circumstance?

16. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Provider-Pharm Rep Interaction

17. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Does offering CME credit change this? (Please enter your answer below)

18. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Percent of respondents who agreed the following gifts were influential Gibbons RV, et al. J Gen Intern Med. 1998;13(3):151-154.

19. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Making the CA$E for Drug Company Dependence Have you ever prescribed a C ox-2 inhibitor? Do you get A nnoyed by people who complain about lunches & free gifts? Have you felt guilty about receiving $ from pharmaceutical companies? Lunches or dinners? Gifts? Do you drink your morning E ye-opener -- coffee -- out of a pharmaceutical company ‘branded’ mug? Adapted from: No Free Lunch. Available at: www.nofreelunch.orgwww.nofreelunch.org If you answered yes to 1 or more of these questions, you may want to reconsider your practice!

20. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE “While it’s the doctors’ job to treat patients and not to justify their actions, it’s my job to constantly sway the doctors. It’s a job I’m paid and trained to do. Doctors are neither trained nor paid to negotiate.“ -Shahram Ahari Job Training Fugh-Berman A, et al. PLoS Med. 2007;4(4):e150. “…change the prescribing habits of physicians.” -James Reidy

21. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Focus group data “They stopped allowing reps in my office and this one had information for me, so I told her she could join me for a run. She went not only the extra mile, but an extra 2 miles and talked to me about the product the whole way. That was really helpful. You bet I still see her any time she wants to see me.” “Sometimes we don’t even talk about drugs, we just chat about the kids and it’s good to have a relaxed and friendly lunch.” “I must admit that for all the years that I have been prescribing drugs and practicing, I have always been conflicted about that, especially when I look at the drug sample closet and some of the perks that some of the physicians get, I admit to being conflicted about that aspect of marketing.” Fischer MA, et al. Unpublished data; Manuscript in submission.

22. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 5 Minute Pharm Rep Interaction 1.Take Control 2.Learn the Indications 3.Determine the Clinical Benefits and Safety 4.Compare to Other Medications 5.Consider Patient and Company Factors

23. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Take Control

24. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Policy Details If you decide to allow pharm rep visits –What is the specific reason? –Will they have free access or scheduled appointments? –Can they bring food? Samples? –What areas of the clinic can they visit? –Can they bring gifts and give-aways for staff or patients? –What about off-site CME or CEU programs?

25. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 1. Take Control Determine your own level of comfort with this power Know your own personal bias and preference Be clear about how much time you have to spend and where you will meet with the pharm reps

26. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Learn the Indications

27. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 2. Learn the Indications What is the approved indication for this medication? Which specific patient population will it benefit? Does this medication fit an otherwise unmet need? When does the patent expire? Or is there a generic available?

28. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Determine the Clinical Benefits and Safety

29. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 3. Determine the Clinical Benefits and Safety What are the specific clinical benefits? Is there any primary data? What are the most serious side effects? Which are the most problematic for patients? Are there any ongoing phase 4 trials?

30. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Compare to Other Medications

31. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 4. Compare to Other Medications What differentiates your product from its competitors? How does it compare to other medications with respect to: –Efficacy? –Contraindications? –Side effects? –Cost and formulary coverage? Are there any head-to-head trials of your medication and the gold standard?

32. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Consider Patient and Company Factors

33. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 5. Consider Patient and Company Factors Does your company have an indigent patient program? How does a patient apply? Does your company provide CME programs? Has your company ever been cited by the FDA for off label marketing? What percentage of your company’s revenue is spent on researching new molecules? To understand why this is important please see our module on the pharmaceutical development cycle

34. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Which of these skills do you think would be most helpful? (Please enter your answer below)

35. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Key Points Pharm reps are trained and paid to impact prescribing Prescribers hold the power in pharm rep interactions Personal and organizational policies may help Controlling interactions and using specific questions may improve appropriate prescribing

36. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Key Points – 5 Minute Pharm Rep Interaction Take Control Learn the Indications Determine the Clinical Benefits and Safety Compare to Other Medications Consider Patient and Company Factors

37. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Recommendations Help to develop or reinforce local policy for interacting with pharmaceutical reps Ensure all aspects of the interactions meet specific objectives Identify and use independent, reliable resources for patient education and continuing medical education Practice using the 5-minute PR interaction model

38. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE  Fischer MA, Keough ME, Baril J, Saccocio L, Mazor KM, Ladd E, Von Worley A, Gurwitz J. Attitudes of prescribers towards pharmaceutical marketing: needs assessment and implications for training and policy. Unpublished data; Manuscript in submission.  Fugh-Berman A, Ahari S. Following the script: how drug reps make friends and influence doctors. PLoS Med. 2007;4(4):e150.  Gibbons RV, Landry FJ, Blouch DL, Jones DL, Williams FK, Lucey CR, Kroenke K. A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts. J Gen Intern Med. 1998;13(3):151- 154.  No Free Lunch. Available at: www.nofreelunch.orgwww.nofreelunch.org  Partners HealthCare. Policy on interactions with pharmaceutical and medical device companies. Available at: http://www.partners.org/vendor/Interactions%20w%20Pharm%20and%20Device%20Companies.pdf Accessed August 21, 2008. http://www.partners.org/vendor/Interactions%20w%20Pharm%20and%20Device%20Companies.pdf  Stanford School of Medicine. Policy and guidelines for interactions between the Stanford University School of Medicine, the Stanford Hospital and Clinics, and Lucile Packard Children's Hospital with the pharmaceutical, biotech, medical device, and hospital and research equipment and supplies industries ("Industry"). Available at: http://med.stanford.edu/coi/siip/policy.html Accessed August 20, 2008.http://med.stanford.edu/coi/siip/policy.html  Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med. 2001;110(7):551-557.  UMass Memorial Medical Center. Policy Manual. # 1143 Policy on Vendor Relationships. Effective Date: 7/1/2008. Available at: http://www.umassmemorial.org/workfiles/Med%20Center%20PDFs/1143%20Policy%20on%20Vendor%20Re lationships.pdf Accessed August 18, 2008. http://www.umassmemorial.org/workfiles/Med%20Center%20PDFs/1143%20Policy%20on%20Vendor%20Re lationships.pdf References

39. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Resources Consumer Reports Best Buy Drugs http://www.consumerreports.org/health/best-buy-drugs/index.htm Journal Watch http://www.jwatch.org/ Medical Letter http://www.medicalletter.org/ Medline (through the U.S. National Library of Medicine) http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed Attorney General Consumer and Prescriber Education Grant Program Initiated Resources Brigham & Women's Hospitalhttp://www.rxfacts.org/http://www.rxfacts.org/ Georgetown Universityhttp://www.pharmedout.org/http://www.pharmedout.org/ MGH Institute of Health Professionalshttp://www.perxinfo.org/perx.htmlhttp://www.perxinfo.org/perx.html University of Kentuckyhttp://www.cecentral.com/http://www.cecentral.com/ University of North Carolina, Chapel Hillhttp://harryguess.unc.edu/http://harryguess.unc.edu/ University of Massachusetts Medical School/http://www.umassmed.edu/meyers/index.aspxhttp://www.umassmed.edu/meyers/index.aspx Meyers Primary Care Institute

40. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Resources Institutions with Available Policies  Partners HealthCare  http://www.partners.org/vendor/Interactions%20w%20Pharm%20and%20Devic e%20Companies.pdf http://www.partners.org/vendor/Interactions%20w%20Pharm%20and%20Devic e%20Companies.pdf  Stanford School of Medicine  http://med.stanford.edu/coi/siip/policy.html http://med.stanford.edu/coi/siip/policy.html  UMass Memorial Health Care  http://www.umassmemorial.org/workfiles/Med%20Center%20PDFs/1143%20Po licy%20on%20Vendor%20Relationships.pdf http://www.umassmemorial.org/workfiles/Med%20Center%20PDFs/1143%20Po licy%20on%20Vendor%20Relationships.pdf

41. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Resources Policy Checklist First check to see if your organization or sponsor has a policy for interacting with PRs. Does it cover all of the necessary features? What is the specific reason? Will they have free access or scheduled appointments? Can they bring food? Can they bring samples? What areas of the clinic can they visit? Can they bring gifts and give-aways for staff or patients? Before implementing a new policy, consider the risks and benefits of such a policy to both your interactions with PR and patients Develop your own personal policy for interactions with PRs (CME, dinner programs, etc) If necessary, work with your office team to develop a policy with broad acceptance (school, hospital, organization, etc)

42. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Resources  Communicating with Patients  Evidence-Based Medicine (EBM)  Organizational Influences on Prescribing  Pharmaceutical Development and Regulation  Pharmaceutical Marketing  Links to Web-Access and Downloadable Versions Available at: http://www.umassmed.edu/meyers/index.aspx http://www.umassmed.edu/meyers/index.aspx Additional Learning Modules in This Series

43. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 1. On average, patients believe that drug samples are more likely to influence prescribing than physicians. A. True B. False Questions

44. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 1. A: False. Patients and physician responses were about equal according to a study published in JGIM in 1998, with approximately 22% of patients and 27% of physicians feeling drug samples were influential. Both groups felt that trips or dinners were even more inappropriate.

45. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 2. Independent online or print resources useful education handouts to support your communication. A. True B. False Questions

46. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 2. A: True. These resources should be free of bias from sponsoring organizations. Please review the resources section at the end of the module for suggested unbiased sites.

47. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 3. Which of the following questions most demonstrates learn the indications? A. Does your company have an indigent patient program? B. Are there any head-to-head trials of your medication and the gold standard? C. Does this medication fit an otherwise unmet need? D. What are the most serious side effects of your medication? Questions

48. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 3. C: Does this medication fit an otherwise unmet need? This question helps you to understand the best use for a pharmaceutical agent. You can also ask what the FDA approved indications are. The others may also be important to help you take control meetings with pharmaceutical representatives.

49. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 4. Which of the following questions most demonstrates determine clinical benefits and safety? A. Does your company have an indigent patient program? B. Are there any head-to-head trials of your medication and the gold standard? C. Does this medication fit an otherwise unmet need? D. What are the most serious side effects of your medication? Questions

50. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 4. D: What are the most serious side effects of your medication? You may also ask what the most common side effects are or whether they resolve over time.

51. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 5. Which of the following questions most demonstrates compare to other medications? A. Does your company have an indigent patient program? B. Are there any head-to-head trials of your medication and the gold standard? C. Does this medication fit an otherwise unmet need? D. What are the most serious side effects of your medication? Questions

52. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 5. B: Are there any head-to-head trials of your medication and the gold standard? Recall that many new drugs are compared to placebo rather than gold standard. Please see our EBM module for more information regarding pharmaceutical trials.

53. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 6. Which of the following questions most demonstrates consider patient and company factors? A. Does your company have an indigent patient program? B. Are there any head-to-head trials of your medication and the gold standard? C. Does this medication fit an otherwise unmet need? D. What are the most serious side effects of your medication? Questions

54. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 6. A: Does your company have an indigent patient program? These can be very helpful in facilitating patient use of appropriate medications that may otherwise be prohibitively expensive.

55. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 7. A prescriber can take control of interactions with pharmaceutical representatives by: A. Declining to meet with them. B. Determining specific objectives to meeting with them and ensuring all interactions support those objectives. C. Following the 5-minute pharm rep interaction model. D. Developing or supporting a local policy that limits undue influence of pharm reps on prescribing. E. All of the above. Questions

56. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 7. E: All of the above. The first step in the 5-minute PHARM REP interaction is Take Control. Initially you must decide whether or not to allow pharmaceutical representative visits at all. If you or your group decide to allow pharmaceutical representatives to market in your clinic, development of a specific and consistent policy for yourself and your clinic may help you succeed in maximizing educational and patient benefit while minimizing inappropriate influence. While each of the selections may be helpful, we do not expect that you will use each of them in every encounter.

57. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hi Dr. Smith, Constance Ramos following up on our discussion last month about GUDAZNU. Have you had a chance to try it on any patients yet? Can I leave you a few coupons to help out with the initial prescription for your patients?” 8. The pharmaceutical representative in this video is offering the provider coupons to help patients get discounts on her drug. Which response best demonstrates taking control? A. Thank you, I am sure that these coupons will be helpful to my patients. I’m glad to be able to offer them this assistance. B. Thank you, I’ll be happy to use them with my patients who may have difficulty affording your drug. C. No thank you, I don’t accept coupons but you can leave them in the waiting area for patients to access if you would like. D. No thank you, since our last visit we have enacted a policy that we will not meet with pharmaceutical representatives. Questions

58. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 8. D: No thank you, since our last visit we have enacted a policy that we will not meet with pharmaceutical representatives. This response clearly shows that you have considered your policy since your visit with the representative the prior month and have determined you will take control by not continuing these interactions. The others offer a more passive response.

59. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 9. In order to help build and maintain their own knowledge regarding prescribing, providers should become comfortable with independent, reputable online or print resources. A. True B. False Questions

60. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 9. A: True. Please see the resources section at the end of each module for lists of helpful resources.

61. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 10. One retired pharmaceutical representative described the unofficial job description of a pharmaceutical representative as “chang[ing] the prescribing habits of physicians.” A. True B. False Questions

62. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Answer 10. A: True. It is important for prescribers to understand this goal to help determine whether they want to participate in meetings with pharmaceutical representatives.

63. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hello Dr. Smith, I’m Constance Ramos with GBU Pharmaceuticals. I’d like to talk with you for a couple of minutes about our new therapeutic agent GUDAZNU, if you could spare the time. I know that your patient population would benefit tremendously from this treatment.” 11. How might you respond to this introduction using the 5-minute pharm rep interaction technique? Questions

64. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hi Dr. Smith, Constance Ramos from GBU Pharmaceuticals. We’re hosting a CME dinner for GUDAZNU next week, would you be interested in attending?” 12. How might you respond to this pharmaceutical representative using the principles of the 5-minute pharm rep interaction? Questions

65. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE Pharm Rep: “Hi Dr. Smith, Constance Ramos from GBU Pharmaceuticals. I’ve just come from your spine clinic where I was talking with Dr. Bakki about GUDAZNU for pain control. He is recommending it for many of his patients. I wonder if you have a minute to talk with me about how it might help in your own practice?” 13. Why do you think this pharmaceutical representative mentions your colleague in the spine clinic when addressing you about her new drug? Questions

66. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 14. I sometimes feel manipulated by pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree 15. I usually feel that I am in control when interacting with pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree Questions

67. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 16. I wish I could be more assertive in my dealings with pharmaceutical representatives. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree 17. I know how to get the information that I need from a pharmaceutical representative. A. Strongly Agree B. Agree C. Disagree D. Strongly Disagree Questions

68. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 18. Did completing this module help you to understand why prescribers need to manage pharmaceutical rep interactions? A. Yes, definitely B. Yes, probably C. Probably not D. Definitely not E. Not sure 19. Would you recommend this training module to a colleague? A. Yes, definitely B. Yes, probably C. Probably not D. Definitely not E. Not sure Questions

69. Click to edit Master title style Click to edit Master subtitle style UMASS MEDICAL SCHOOL MEYERS PRIMARY CARE INSTITUTE 20. Will you do anything differently in your practice as a result of this training module? A. Yes, definitely B. Yes, probably C. Probably not D. Definitely not E. Not sure 21. Please tell us about any changes you are considering or planning: Questions