The role of Pharmaceutical Marketing in Prescribing Decisions in a Developing Country: A Comprehensive Study Exploiting Theory of Planned Behaviour

Mahmoud Al-Areefi; Mohamed Izham  Mohamed Ibrahim; Abubakr Abdelraouf Alfadl

doi:10.56338/jphp.v4i3.5860

Mahmoud Al-Areefi Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah, Saudi Arabia
Mohamed Izham Mohamed Ibrahim College of Pharmacy, Qatar University, Doha, Qatar
Abubakr Abdelraouf Alfadl Department of Pharmacy, University of Science and Technology, Aden, Yemen

DOI: https://doi.org/10.56338/jphp.v4i3.5860

Keywords: Drugs, Medical Representatives, Physicians, Prescribing Decision, Promotion, Yemen

Abstract

Background: Prescription medicines have become a major component of health systems in both developed and developing countries contributing to, may be, more than half of the total health care expenditure in the developing countries. Although literature directly attributing rise in medicines expenditure to prescribers’ decision, but still only a few researches had employed studies with sound theoretical foundations to comprehensively examine prescribing decision behaviours. Our objective was to investigate potentially modifiable factors, which may influence prescribing decisions of physicians employing theory of planned behaviour.

Method: A quantitative survey approach was used to investigate the proposed hypotheses. Population was physicians in outpatient clinics in both private and governmental hospitals in Sana’a, capital city of Yemen. A structured questionnaire was designed to measure the influence of drug-promoting marketing techniques on physicians’ prescribing decisions. Data was collected through an anonymous survey questionnaire. The hypotheses were tested by multiple regressions analysis. Ethical approval was obtained from the Ethical Committee of the Ministry of Public Health and Population (MoPHP), and participants provided written consent before enrolling in the study.

Result: Physicians admitted the presence of promotional influence on their prescribing decision. The study revealed that receiving low-value promotional items, belief of physicians that it is appropriate to accept both low- and high-value promotional items, physicians’ exposure to company-direct sources of information, and drug promotion-related factor all are positively and significantly related to physicians’ prescribing decisions (? = 0.438, p <0.001; ? = 0.089, p =0.027; ? = 0.157, p <0.001; ? = 0.093, p =0.032; and ?= 0.118, p = 0.007 respectively).

Conclusion: This research clarified the role played by pharmaceutical companies to influence prescribing decisions of physicians. Therefore, could provide theoretical framework for policymakers in Yemen, and other countries with similar conditions, to develop a suitable policy and strategy in terms of drug promotion.

References

World Health Organization. Options for financing and optimizing medicines in resource-poor countries. (No. HSS/HSF/DP. E. 10.7). WHO; 2010.

OECD. Health at a Glance. OECD Indicators, OECD Publishing; 2017.

Morgan SG, Leopold C, Wagner AK. Drivers of expenditure on primary care prescription drugs in 10 high-income countries with universal health coverage. CMAJ. 2017;189(23):E794-9.

Hossain M, Kawsar S, Tanmy T, Yousuf A. Assessment of influencing factors on prescription practices of physicians in Bangladesh. Int Res J Pharm. 2013;4:112-6.

Schumock GT, Stubbings J, Hoffman JM, Wiest MD, Suda KJ, Rim MH, et al. National trends in prescription drug expenditures and projections for 2019. Am J Health Syst Pharm. 2019;76(15):1105-1121.

Murshid MA, Mohaidin Z. Models and theories of prescribing decisions: A review and suggested a new model. Pharm Pract (Granada). 2017;15(2). doi: 10.18549/PharmPract.2017.02.990.

Davari M, Khorasani E, Tigabu BM. Factors influencing prescribing decisions of physicians: a review. Ethiop J Health Sci. 2018;28(6).

Khazzaka M. Pharmaceutical marketing strategies' influence on physicians' prescribing pattern in Lebanon: ethics, gifts, and samples. BMC Health Serv Res. 2019;19(1):1–11.

Almasri M, Bukhari YR, Alzuair BS, Almadi MK, Abdulrahman AK. Ethical considerations in doctors & pharmaceutical industries relationship: a narrative review. Int J Med Dev Countries. 2020;4(1):244–52.

Theodorou M, Tsiantou V, Pavlakis A, Maniadakis N, Fragoulakis V, Pavi E, et al. Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey. BMC Health Serv Res. 2009;9:150.

Ponnet K, Wouters E, Van Hal G, Heirman W, Walrave M. Determinants of physicians’ prescribing behaviour of methylphenidate for cognitive enhancement. Psychol Health Med. 2014;19(3):286-295.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. https://doi.org/10.1016/0749-5978(91)90020-T.

Al-Areefi MA, Hassali MA. Physicians’ perceptions of medical representative visits in Yemen: a qualitative study. BMC Health Serv Res. 2013a; 13: 331.

Al-Areefi MA, Hassali MA. The role of pharmaceutical marketing and other factors in prescribing decisions: the Yemeni experience. Res Social Adm Pharm. 2013b;9(6):981-8. doi: 10.1016/j.sapharm.2012.10.006.

Al-Areefi MA, Hassali MA, Ibrahim MI. A qualitative study exploring medical representatives’ views on current drug promotion techniques in Yemen. J Medical Mark. 2012;12(3):143-9.

Cochran, William G. Sampling techniques. New York: John Wiley and Sons; 1963.

Nunnally JC, Bernstein IH, Berge JMF. Psychometric theory, New York: McGraw-Hill. 1967.

Hailu AD, Workneh BD, Kahissay MH. Influence of pharmaceutical marketing mix strategies on physicians’ prescribing behaviors in public and private hospitals, Dessie, Ethiopia: a mixed study design. BMC Public Health. 2021;21(1):1-5.

Tušek-Bunc K, Kersnik J, Petek-Šter M, Petek D, Klemenc-Ketiš Z. Explanatory model of prescribing behavior in prescription of statins in family practice. Wien Klin Wochenschr. 2010;122(2):79-84.

Murshid MA, Mohaidin Z, Zayed M. Development and validation of an instrument designed to measure factors influencing physician prescribing decisions. Pharm Pract (Granada). 2019;17(4).

Lieb K, Brandtönies S. A survey of German physicians in private practice about contacts with pharmaceutical sales representatives. Dtsch Arztebl Int. 2010;107(22):392.

Faisal A, Ahmad MS, Thurasamy R, Ahmed R. Doctors’ interactions with pharmaceutical sales representatives: Modelling doctors prescription behaviour. Community Ment Health J. 2020;56(3):456-63.

Sharifnia SH, Mohammadzadeh M, Arzani G, Salamzadeh J, Abolfazli SA, Zali A, et al. Main factors affecting physicians’ prescribing decisions: the Iranian experience. Iran J Pharm Res: IJPR. 2018;17(3):1105-1115.

Ali KE, Naser AY, Al-Rousan R, Alwafi H, AbuAlhommos AK, Alsairafi ZK, Salawati EM, Samannodi M, Dairi MS. The attitude and acceptability towards medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq: a cross-sectional study. BMC Health Serv Res. 2022;22(1):105.

Waheed KA, Jaleel M, Laeequddin M. Prescription loyalty behavior of physicians: an empirical study in India. Int J Pharm Healthc Mark. 2011; 5:279-298.

Tran VD, Cao NT, Le MH, Pham DT, Nguyen KT, Dorofeeva VV, et al. Medical staff perspective on factors influencing their prescribing decisions: a cross-sectional study in Mekong Delta, Vietnam. J Pharm Health Serv Res. 2021;12(2):122-32.

Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open. 2017;7(9):e016408.

Alowi M, Kani YA. Impact of pharmaceutical companies’ promotional tools on physicians’ prescription patterns: a systematic review. J Appl Pharm. 2018;10:3.

Dabboor E, Al-Ghadir H, Al-Gasawneh JA, Nusairat NM, Hammouri Q. Factors Affecting Physicians Prescriptions: an Empirical Study on Jordanian General Physicians. Ann Rom Soc Cell Biol. 2021;25(6):18631-47.

Eyad Mustafa Al-ghanem. The Impact of Brand Equity of Global Pharmaceutical Companies on Prescriptions Decisions of Physicians in Jordan: The Moderating Role the Performance of Medical Representatives. Research in World Economy. 2021;12:302.

Skoglund I, Bjorkelund C, Mehlig K, Gunnarsson R, Moller M. GPs’ opinions of public and industrial information regarding drugs: a cross-sectional study. BMC Health Serv Res. 2011;11(1):1-8.

Parli K, Reema R, Devang R, Supriya M. Evaluation of promotional drug literature provided by medical representative at a tertiary care hospital. Int J Pharm Sci Res. 2017;8(4):1744.

Hailu HG, Gobezie MY, Yesuf TA, Workneh BD. Critical evaluation of the validity of drug promotion materials in Ethiopia. Drug Healthc Patient Saf. 2019;11:47.