In 2019, the Therapeutics Initiative completed its fifth readership survey to evaluate perceptions of our academic unit and the impact of TI events. We conducted similar surveys in 1996, 2000, 2006, and 2011. In 2019 we invited a 10% random sample of all registered pharmacists in British Columbia (N=588) and a 10% random sample of physicians who receive our letter by mail (N=643) to participate in this survey. We sent repeated reminders to non-responders over a 3 month period, ultimately generating responses from 34% of pharmacists and 29% of physicians sampled.
Figure 1: Survey responders (N=385)
The Therapeutics Initiative maintains an e-subscriber list of over 4,000 people who signed up for receiving email notices regarding newly published Therapeutics Letters, upcoming continuing education events, and new reports or videos posted to our website. About 1,500 of them are BC residents, the rest are mostly from other Canadian provinces, the US, Latin America and Europe. This includes readers of the Spanish translation of the Therapeutics Letter. We sent a survey link to all e-subscribers, asking the same questions as the survey that was sent to the randomized sample of physicians and pharmacists.
Responses from e-subscribers were largely supportive of our work and similar to those from the the randomized sample of BC physicians and pharmacists. Of the 483 responders to the e-subscriber survey who self-identified, 81% are pharmacists, physicians, specialists or nurses/ nurse practitioners. The remaining 19% includes patients/consumers, policymakers, students, journalists and pharmaceutical reps.
Our randomized survey indicates that over three-quarters of responding pharmacists and specialists, and 9 out of 10 family physicians agreed that the TI provides useful information (Figure 2).
Figure 2: % of responders who somewhat or strongly agree that: “The TI provides information that I use in my practice”
Our mandate is to provide physicians and pharmacists with up-to-date, unbiased, evidence based, practical information about drug therapy. More than 80% of responding pharmacists, 85% of family physicians and over half of specialists somewhat or strongly agreed that the TI was meeting its mandate.
Figure 3: % of responders who somewhat or strongly agree that: “the TI successfully fulfills its mandate”
Do users regard information in the Therapeutics Letter as accurate and unbiased? In 2019, 84% of responding family physicians and just over 80% of pharmacists somewhat or strongly agreed that Therapeutics Letters are accurate and unbiased. Specialists were more sceptical: only 55% agreed.
Figure 4: % of responders who somewhat or strongly agree that “the Therapeutics Letters are accurate and unbiased”
Print or online?
Twenty years ago we asked our readers if they consulted the website of the Therapeutics Initiative and 22% of pharmacists and 9% of physicians said they did. When we asked in 2006 and 2011 whether recipients preferred the Therapeutics Letter online or in print, most MDs and pharmacists preferred the print format. In our 2019 random sample, 69% of physicians but only 11% of pharmacists still prefer the print version. The remainder prefer to read the Therapeutics Letter online or to access both online and print sources.
Over our 25-year history, our principal target audience consistently values the TI’s work. We enjoy significant trust from healthcare providers in BC and beyond. Specialists appear more sceptical, but our survey provides little insight into why. We have learned from continuing education events that family physicians, nurse practitioners, and pharmacists often view therapeutic issues differently from specialists, including colleagues they regularly work with and respect.
Assisting practitioners to use drugs wisely is a challenge that we find increasingly difficult. A profusion of new drugs (including many direct competitors with similar mechanisms of action), the complexity of clinical trials, and development of new techniques in pharmacoepidemiology and network meta-analysis has made it harder to understand “pharmacoreality”. Interpreting outcomes with variable definitions (both surrogate or clinically important) and accessing and understanding unpublished information from regulatory agencies and clinical study reports are now far more challenging than when we began our work in 1994.
How can we best help practitioners to adapt “evidence” from RCTs and guidelines to the needs of their own individual patients? How best to ensure that long-term harms as well as benefits from drug therapies are considered, for example the development of pharmacological dependence, or of subtle harms not identified during typically brief RCTs?
Whether you are a regular reader, or new to the Therapeutics Letter we welcome your feedback. Would you like to help review our draft Therapeutics Letters? Do you have ideas on how we can be more effective? Would you like us to visit your community? Send us your thoughts.