Justin W. Marson MD,a Graham H. Litchman DO MS,b Darrell S. Rigel MD MSc
aNational Society for Cutaneous Medicine, New York, NY bDepartment of Dermatology, St. John’s Episcopal Hospital, New York, NY cDepartment of Dermatology, NYU Grossman School of Medicine, New York, NY
Background: COVID-19 has had significant negative economic ramifications on dermatologic care delivery, including curtailing live on-site physician-pharmaceutical-representative interactions (PPRI). Objective: To determine the impact of COVID-19 and pandemic regulations on current and future PPRI. Methods: Cross-sectional survey-based study that analyzed data from 400 surveyed dermatologists using a pre-validated questionnaire sent via email. Data regarding PPRI were collected over 1 week in July 2020 to compare demographics and practice standards from April 2019, April 2020, July 2020, and predictions for 2021. Results: Virtual-only PPRI increased from 7.8% in April 2019 to 26.5% during April 2020 (mean difference, 18.8%; 95% confidence interval, 13.6%–23.9%). Virtual-only PPRI remained elevated at 24.5% while hybrid PPRI increased, eventually surpassing the April 2019 mark (27.0%). These trends persisted among all studied practice types and levels of experience. Practices predicted no significant percent differences in participation in PPRI (87.3% vs 90.3%; P=0.0834), but a significant shift in method of delivery where the odds ratio of incorporating a virtual component into PPRI in 2021 increased by a factor of 3. Limitations: Relatively small sample size, especially among subgroups. Responses may have been retrospective estimates. There may also be selection bias given slightly increased representation of more experienced dermatologists. Conclusion: PPRI materially decreased during the initial COVID-19 peak but will likely return to baseline volume moving forward with a significant component being hybrid PPRI. Further studies may better elucidate the economic and clinical impact associated with these changes and their effect on dermatologists’ ability to provide patients with samples and educational materials.
COVID-19 had a significant impact on dermatologistsâ€™ ability to treat patients.1 Practice restrictions and closures have decreased patient volumes with significant negative economic ramifications on dermatologic care delivery.2,3 Pharmaceutical company representatives interact with dermatologists to provide information on drugs and samples for patient usage. Given the restrictions on and closure of dermatology practices during the pandemic, live on-site physician-pharmaceutical-representative interactions (PPRI) were materially curtailed. The purpose of this study was to determine the effect of COVID-19 on the magnitude and formats of PPRI during the pandemic compared to the prior year and to assess what changes might occur in future PPRI.
A pre-validated survey assessing PPRI prior to, during and predictions for post COVID-19 was emailed to US dermatologists during July 2020. Data were analyzed from the first 400 valid responses. Statistical significance was calculated using McNemarâ€™s test for paired data and chi-square and the Marascuilo procedure for multiple categorical comparisons. Odds ratios (OR) and confidence intervals (CI) were calculated to facilitate statistical comparisons.
Respondents were 88.3% in private practice and over 60% had at least 20 years of experience (Table 1). At baseline in April 2019, 58.5% of PPRI were face-to-face on-site interactions, 7.8% had virtual-only (email, online video-calls, phone-conferences) interactions and 21.0% of respondents had hybrid (on-site and online) PPRI (Figure 1 and Table 2). 12.8% of respondents reported no on-site PPRI.
In April 2020 during the pandemicâ€™s height, 54.8% of physicians reported no PPRI with 26.3% having concurrent office closures (Table 2). While on-site PPRI reached its low in April 2020, the
virtual-only PPRI format increased from 7.8% in April 2019 to
26.5% during April 2020. Although 22.5% of practices had no
PPRI during July 2020, only 1.8% were closed at this time.
Virtual-only PPRI remained elevated at 24.5% while hybrid PPRI
increased, eventually surpassing the April 2019 mark (27.0%)
(Figure 1 and Table 2). Overall, practices cited concerns about
limiting non-essential office presence (52.0%) and protecting
patients (50.3%)/staff (52.5%) as the top 3 most significant
limitations for on-site PPRI (Table 3 and Table 4).
Comparing 2019 to 2021, there were no significant differences in predicted PPRI access to dermatology offices (87.3% vs 90.3%; P=0.0834) (Table 2). However, practices predicted wide variation as to when to reimplement on-site PPRI with 45.3% of respondents allowing on-site PPRI in July 2020 while 38.3% estimated at least 2021 (Table 5). Although practices predicted similar virtual-only PPRI usage in 2021 compared to 2019 (11.3% vs 7.8%; P=0.0614), they anticipated significantly more hybrid PPRI in 2021 (42.5% vs 21.0; P<0.0001). The chance of practices planning to utilize virtual PPRI (OR 3.0) or hybrid PPRI (OR 3.2) in 2021 increased by a factor of 3 (Table 6).
Nearly all subgroups predicted increasing hybrid PPRI and decreasing on-site PPRI in 2021. Solo (61.8% vs 44.4%; P=0.0026) and group (61.2% vs 31.5%; P<0.0001) private dermatology practices envision significantly less on-site PPRI, supplementing this decrease with significantly more hybrid PPRI (Solo: 22.9% vs 45.8%; P<0.0001; Group: 22.4% vs 47.3%; P<0.0001) (Table 7). Furthermore, private group dermatology practices predicted significantly more virtual-only PPRI (7.3% vs 14.5%; P=0.0446). Academic/government and multi-specialty practices showed similar trends in decreasing on-site PPRI (Academic/government: 42.6% vs 25.5%; P=0.0433; Multi-specialty: 54.5% vs 40.9%; P=0.1336, respectively) and increasing hybrid PPRI (Academic/ government: 21.3% vs 31.9%; P=0.2278; Multi-specialty: 9.1% vs 25.0%; P=0.0455, respectively). Dermatologists of all levels of experience also predicted decreasing on-site PPRI (0 to 20 years: 57.0% vs 31.0%; P<0.0001; 21â€“30 years: 59.5% vs 35.5%, P<0.0001; 31+ years, 59.1% vs 43.1%; P=0.0023) and increasing hybrid PPRI (0 to 20 years: 19.7% vs 43.7%; P<0.0001; 21â€“30 years: 21.5% vs 42.1%; P<0.0001; 31+ years, 21.9% vs 41.6%; <0.0001) (Table 8). Younger dermatologists were more likely to embrace future virtual interactions. Comparing ORs across years of experience, there was an inverse trend where increasing years of experience correlated with decreased odds of incorporating hybrid or virtual-only PPRI.
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