[124] Your views of the Therapeutics Initiative: 2019 Survey

[124] Your views of the Therapeutics Initiative: 2019 Survey

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)

E-subscriber survey

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.

“I use information from TI almost daily.” — Family physician


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”

“I think one area that TI does not tackle well is the reaction to their publications: “okay, if not that, then what?” — Pharmacist


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.

“I love the TI, a great source of best evidence. I need to remind myself to access your website regularly.” — Family physician


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.

“I encourage my co-workers in our hospital pharmacy to read and discuss the TI Letters” — Pharmacist

Send us your thoughts. We post interesting comments if contributors have given permission and completed the standard ICMJE conflict of interest declaration.
The Therapeutics Initiative is funded by the British Columbia Ministry of Health. The Therapeutics Initiative provides evidence-based advice about drug therapy, and is not responsible for formulating or adjudicating provincial drug reimbursement policies.
  • Ian Relf
    Posted at 13:29h, 18 February Reply

    I represent the views of the Australian Medical Acupuncture College Board- that you give a high quality, well researched and accurate depiction of the evidence without the ‘spin’. We note the variable views of physicians who also have a poor track record of prescribing in relation to the particular sponsoring companies. Please continue your excellent work.
    Yours sincerely Dr Ian Relf- Australia

  • Pierre Biron
    Posted at 14:46h, 18 February Reply

    TI appears as the most independent source in general therapeutics in Canada and it is a shame that their editors do not enjoy the budget needed to cover more topics important to patients through a bias-free evaluation of current practices and new products. Neither the CMAJ or the CFP are totally reliable, being too cozy with industry money AND industry lines of thoughts.
    It is the only member of the ISDB (independent bulletins) in this country

    My ideal CME, (mostly) for general practitioners and pharmacists, is Prescrire, edited in Paris. 84 pages each month of short reviews in diagnostics and therapeutics, with hundred of unpaid outside reviewers and dozen of part-time and full-time editors all paid from subscriptions, no sponsors. TI letters cannot compete in scope but their quality is excellent. I guess it would take a miracle to find a generous sponsor that would provide more staff, as qualified and as well focused on reliable and transparent reviews in fields not covered by learned journals that are unable or unwilling to criticize the mainstream aberrations seen in modern medicine.

    Kudos to the TI and long live its editors.

    Pierre Biron, retired medical pharmacologist

  • Susanne Voetmann
    Posted at 14:04h, 19 February Reply

    I am no longer active clinically but continue to follow Therapeutics Initiative and intend to as long as I am able.

    Posted at 14:10h, 19 February Reply

    The most important messages are often so difficult to get out and to be trusted. The most important adjective is the word “unbiased,” which TI is known for, and for which I have regularly relied on in my work. As the comments indicate, it is unfortunate that funding is a constant difficulty in such important work. Please keep doing the same, and I now rely more on the electronic access, and the associated notices.
    A steady fan here for sure.

  • Rob
    Posted at 14:55h, 23 February Reply

    I have been reading the TI letters and attending TI conferences for many years. I find the information useful in assisting me in making therapeutic choices. I do not always agree with recommendations but “a touch of cynicism is a good thing”.
    Keep up the good work TI.

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