Britain’s state-financed health-care system prides itself on providing care for all. But the system’s funding pinch is causing some doctors’ offices to rely on financial support from the pharmaceutical industry, The Wall Street Journal reports.

Drugmakers are paying for nurses to study patient charts to identify people with chronic illnesses. The nurses, who come from nursing contractors, then recommend which patients should be called in for a check-up and perhaps prescribed new treatment - sometimes a medicine made by the company funding the nurses. The work is part of what the industry calls “disease management programs,” which drugmakers say improve care for people with illnesses like diabetes, asthma or heart disease.

The risk, however, is that companies use the programs as a back door for marketing pills. The programs also raise concerns about patient privacy. Last fall, the Association of the British Pharmaceutical Industry, a trade group, temporarily suspended Merck’s UK subsidiary from its ranks after finding Merck used a program for patients with high blood pressure to promote its drug Cozaar.

Drug companies are “doing this on the hope that they will get their fair share of prescriptions out of it,” says Steve Kerridge, head of In2Focus, a U.K. firm that provides nurses for the projects.

Jim Kennedy, a physician from Middlesex, England, says he’s turned down offers from drug reps to send special nurse teams to his practice. There is a “perceived or real risk of the pharmaceutical companies’ interests taking precedence over the patients’ interests,” says Dr. Kennedy, who is also the spokesman for the Royal College of General Practitioners, a professional group. He says many doctors in his group share his concern.

This is the rest of the story that appears in The Wall Street Journal:

While company-sponsored nurse teams are most common in Britain, the practice is growing in other countries that also pay for medical care including Belgium, Germany and Ireland, says Hywell Evans, head of the European unit of Quintiles Transnational Corp., a company based in Research Triangle Park, N.C., that provides nurses and other services to drug companies.

The U.S. runs industry-sponsored disease-management programs, too, but most often are targeted at patients on Medicaid or Medicare. The biggest programs to date have been financed by Pfizer Inc., which has a subsidiary called Pfizer Health Solutions to manage the projects.

From 2001 through 2005, Pfizer sponsored a program for tens of thousands of Florida Medicaid patients with chronic illnesses such as asthma, diabetes and heart disease. A team of Pfizer-sponsored nurses and care managers kept in touch with patients by phone or through personal visits, encouraging them to eat well, exercise and take their medication. Pfizer promised to save the state money by reducing the patients’ need for costly emergency care. In return, Florida agreed to give Pfizer drugs preferred status in the Medicaid program. Opinions are divided as to whether the program saved Florida money.

Karen Sweeney, a nurse with Quintiles’s Innovex UK Ltd. unit, in Bracknell, England, has combed through patient records at a doctor’s office in southeast England, looking for asthmatics who were using an abnormally high number of inhalers. The doctor wrote letters inviting the patients she identified to come in for a check-up and most did, Ms. Sweeney says. The letter explained they would be seeing a nurse paid for by a pharmaceutical company. Innovex declines to disclose which firm.

Ms. Sweeney measured how well the patients’ lungs worked and made sure they knew how to check their lungs themselves with a hand-held meter. She also asked what medication they were taking to determine whether they were taking it correctly, she says. If she felt the patient might need a different treatment, she would refer the person to the doctor for another check-up. She says she didn’t feel pressure to steer patients toward her sponsor company’s drugs.

“As a nurse, my priority is providing good patient care,” Ms. Sweeney says. “I can’t be seen even using a pen from a drug company.”

French drug maker Sanofi-Aventis SA is currently providing nurses and training materials to train staff nurses in doctors’ offices across Britain in how to spot patients at risk for cardiovascular disease or diabetes. The materials do not promote Sanofi products, a company spokeswoman said.

Pfizer recently completed an 18-month program in North London that it financed jointly with the National Health Service to add nurses to hospitals to see patients with cardiovascular disease or diabetes. Doctors referred patients to the nurses, who discussed treatment, including lifestyle changes to manage their disease, says John Sory, vice president of Pfizer Health Solutions.

Such work helps make health care more efficient by focusing on preventative steps patients can take, Mr. Sory says. “It’s not a way for us to be promoting our medicines.”

In a recent program for coronary heart disease funded by several big drug companies, outside nurses spent about six months searching patient records for people with heart disease.

The program, in northwest London, cost about $80,000 and was carefully policed by the NHS to ensure drug companies weren’t promoting their brands, says Shailen Rao, who until recently was head of medicines management for 53 state-financed doctors’ offices in Hillingdon, England, which took part in the program. He is now an independent consultant.

While it would be better if the state could pay, it doesn’t have the money, and the program helped patient care, Dr. Rao says.

The nurses hired by the drug companies may see patient records but are prohibited by law from passing any patient information to the drug companies. Britain’s pharmaceutical industry association has drawn up a code of conduct that bars drug companies from using the programs to mention or promote drugs. The code also mandates that programs must enhance patient care or benefit the NHS.

In the program at Dr. Rao’s offices, physicians decided that the program was in the patients’ best interest and gave their consent for the nurse teams to look over patient records, Dr. Rao says.

The Royal College of Nursing, a professional organization, says hired-gun nurses should not be allowed to review patient records without the patients’ consent. “Generally patients don’t object to other professionals seeing their records. But they should be asked permission,” says Lynn Young, the College’s primary health-care adviser.

In the program that resulted in Merck’s recent temporary suspension, the company had been paying for nurses to review patients with high blood pressure in doctors’ offices across Britain since 2004. In March 2006, a Merck sales representative filed a complaint with the Prescription Medicines Code of Practice Authority, a U.K. watchdog, alleging that the company was trying to use the program to promote its drug Cozaar.

The watchdog body found that Merck had instructed its sales reps to offer the program to doctors who were big prescribers of Cozaar, making the program a reward for high prescribers of the drug. The group suspended Merck for three months and forced it to write a letter to doctors in the program alerting them to the violation and apologizing. The company said in a statement at the time that it took the breach “very seriously,” and that it “is working hard on corrective actions.”