The Impact of Pharmaceutical Promotion practices on Prescribing Behaviour of Physicians
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1 The Impact of Pharmaceutical Promotion practices on Prescribing Behaviour of Physicians Ankush Research Scholar University Business School, Panjab University, Chandigarh, Assistant Professor at GGDSD college, Chandigarh ABSTRACT The pharmaceutical industry employs a bizarre mixture of advertising and promotional efforts to manipulate the physicians who write the prescription for drugs to be used by the eventual customer. The participation of physicians as key choice makers is the explanation that they are the centre of most promotional efforts of pharmaceutical companies. Therefore, influencing the physician is an answer to the pharmaceutical sales, and the pharmaceutical companies are spending a lot of capital on advertising their products to the physicians. This study was conducted to investigate the impact of pharmaceutical promotion practices on prescribing behaviour of physicians and deciding the promotional tools that are most valuable in influencing the prescribing behaviour. A Cross-sectional survey was used to gather data through self-administered survey from physicians in Chandigarh and Mohali. Clustered sampling method was used to opt for respondents and data was collected from 470 questionnaires. The data superiority was guaranteed prior to data gathering through pilot testing and skilled assessment. The data representativeness was assessed through KMO and reliability of the constructs was assessed through Cronbach alpha tests.data reduction was done through factor analysis whereas ANOVA, F-test, and Independent-Sample t-test has been applied to test the hypothesis of the study. The result shows that image tactic has been supposed to be the most significant factor while sales promotion strategy has been supposed to be second most significant factor. Keywords: Pharmaceutical industry, Physicians, Promotional Tools, Prescribing behaviour. 1. INTRODUCTION Physicians play a significant job in the health system. They are the most important access for prescribing medicine to their patients. Within both developed and developing countries, recommendation of medicine is one of the most significant factors in the raising expenditure of health services (Forder, 1995). A medicine is prescribed for more than 60% of the residents within Western Europe (Kronker, 1985) (Fraser, 1985) compared to 75 % of meeting in Saudi Arabia that end with a recommendation (Al-Faris, Al-Dayel & Ashton, 1994). India is one of the leading and fastest rising pharmaceutical market in the world.indian Pharmaceutical trade has witnessed a healthy expansion over the past few years with a revenue of approx. US $ 1 billion in 1990 to larger than US $ 20 billion in 2010 as per the report of Government of India. The industry position is 3rd in terms of size and is 14th in terms of worth internationally. Worldwide, it position is 4th in terms of generics manufacturing.large domestic pharmaceutical companies have sustained growth, assuming headship place in a lot of therapies and segments within the Indian market as well as creating a sturdy global exports back-bone. Pharmaceutical sector plays a vital job in the country s financial system and it moreover ensures interests of its people. The pharmaceutical companies are doing expenditure more on marketing than innovation, research and development (Manchanda et al., 2005). The advertising efforts of pharmaceutical companies are engaged towards physicians (medicine prescribers) who are vital judgment makers about medicines and include 542
2 individual selling through medical representatives, medicines samples, physicians meetings and proceedings; and advertisements in medical journals. Physicians that business-related sources had small effect on 68% of them whereas 54% of them that medical representatives were modestly significant in choosing prescriptions. In contrast 62% logical proof was very significant in influencing their prescribing behaviour. However, 88% of physicians that education and scientific knowledge was the most significant factor in their prescribing habits (Avorn, Chen & Hartley, 1982). United Kingdom generated the most significant body intended for guideline of communications with the medical profession, which is organization of the British Pharmaceutical Industry. It incorporated that every gift given to physicians should be of a worth of less than 6. These system have to be more comprehensible and implemented to accomplish the goal (Gitanjali, Shashindran & Tripathi, 1997). 2. REVIEW OF LITERATURE The Competition is escalating day by day in marketing area and one who response within time can survive in the rivalry, same in the field of pharmaceutical marketing, daily various firms bring different brands enhancing the size of market. In this rivalry physicians are the key customers for this industry. Physicians are the only decision makers who decide which brand should be prescribed to their patients. Therefore, all the marketing strategies are being focused towards them (Waheed, Jaleel, & Laeequddin, 2007). Taneja Girish (2008) investigated the influence of promotional tools used by pharmaceutical enterprises on various physicians concluded that physicians in private sector tagged more predominance to personal selling and educational promotional tools whereas DMs gave more predominance scientific promotional tools in comparison to MD and PG diploma doctors. Shamimululhaq et al. (2014) investigated the factors manipulating the physician prescription physicians and concluded that the method salesperson promotes their trade name via using dissimilar promotional tools is largely significant than others. Influencing a physician s prescribing is not merely the consequence of efficient advertising, but is also connected to the class of the information provided and the vulnerability of the beleaguered beneficiary. The boost in prescribing of cyclooxeganase-2 inhibitors inside Australia paralleled their advertising to physicians as safer drugs than established non-steroidal anti-inflammatory drugs (Kerr et. al., 2003). In recent times, the United States Justice Department fined the Glaxo-Smith-Kline(GSK) company $US 3 billion for illegally promoting unconstitutional uses of paroxetine (Paxil) and bupropion (Wellbutrin), and for failing to give details of safety data regarding the diabetes drug rosiglitazone (Avandia) (Hawkes, 2011). Likewise, a study conducted in 2003 exposed that the extreme advertising and endorsement of the drug Gabapentin caused a raise in the quantity of the drug s recommendation for unapproved uses and at unapproved doses (Steinman at al., 2007). This study was conducted to investigate the impact of pharmaceutical promotion practices on prescribing behaviour of physicians and deciding the promotional tools that are most valuable in influencing the prescribing behaviour. 3. RESEARCH DESIGN 3.1 Survey design The questionnaire was advanced based on literature review and deliberation between two authors (A, DK). The questionnaire sought attributes of the physicians and factors influencing their prescription behavior. Pilot study on 30 respondents was done to check its reliability and validity. Questions were asked regarding: 1) Characteristics of the respondents. We asked questions regarding sex, years in practice, specialty, type of organization, family income, education/training, use of personal computers. 543
3 2) Factors influencing prescription behavior. Questions were asked regarding the factors which influence prescription behavior. The factors are personal gifts, sponsorship to conference and drug samples. 3.2 Survey Sample The target population was physicians who are practicing in government and private hospitals in India. Random sampling was not possible in our case because lack of full data of all the physicians in India. Clustered sampling was done in the study. We included Government hospitals of Chandigarh which are PGIMER, Government Muti specialty hospital Sector 16, Government medical college and hospital sector 32 and Civil Hospital 22 and other hospitals in Chandigarh and Mohali. We have not included the physicians who were retired, on leave or working in Administrative roles. The sample size was 470 respondents. 3.3 Survey Administration The survey was administered from April to August On the top of the questionnaire, the purpose of the study was given. The questionnaire was included in the study only when it was returned by deadline (August 30, 2016). The data was entered side by side into Microsoft Excel. 3.4 Statistical Analysis Factor analysis was used for data reduction. ANOVA and Independent sample t-test were used to test the hypothesis. SPSS version 22.0 software was used to find out the relationship between independent and dependent variable. 4. Results DEMOGRAPHIC PROFILE As depicted in Table 1, out of 470 doctors 332 were females doctors which accounts for 70.6 % of the sample and 138 were males, which accounts for 29.4 % of the sample. The physicians in the study who belonged to the age group of years of age were 105(22.3%), while years of age of doctors were 192(40.9%), years of age groups of doctors were 168(35.7)%, while age groups of doctors were 5(1.1%). The number of physicians who were from internal medicines was 64(13.6%) while surgery was 58(12.3%), orthopedics was 50(10.6%), Pediatrics 22(4.7%), Obstetricians/ Gynecologists 68(14.5%), Psychiatrists were 2(0.4%), Opthamologists 14(3%) while others were 192(10.6%). Table 1: Descriptive statistics of the sample Age Gender Specialty Frequency Percentage % % % % Male % Female % Internal Medicine % Surgery % Orthopedics % Pediatrics % Obstetrics/gynecology % Psychiatry 2 0.4% Ophthalmology % Other % 544
4 Factor analysis Barlett s test of sphericity and KMO was used to verify the Sample Adequacy for factor analysis. KMO and Bartlett's Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy..771 Bartlett's Test of Sphericity Approx. Chi-Square df 120 Sig..000 As per table 2, measure of sample adequacy which are Barlett s test of sphericity (approx Chi Square is , degree of freedom is 120, and significance is.000) and KMO value (0.771).It shows that data was established on a sample adequate for factor analysis. Extraction of factors The factors were extracted through principal component analysis and four factors were taken depending on eigen values and variance explained. Eigen value is the total variance explained by each factor. The benchmark way usually used is that factors with an Eigen value of one or more must be extracted. Four factors have eigen value of more than one. Thus four factors have been extracted. The total variance explained by extracted four factors was %. The findings were obtained through rotations with varimax and the factor loadings greater than 0.40 were taken. Table 3: Total Variance explained Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings % of % of Cumulative Varianc Cumulative % of Cumulative Component Total Variance % Total e % Total Variance % Extraction Method: Principal Component Analysis. 545
5 546 Table 4 :Rotated Component Matrix a Component Item No. Promotional tools and approaches Constant Reminder Short Product Name Name easy to pronounce Name related to molecule Mailers from pharma companies Personal gifts Literature/updates/journals Free disease detection camp Incentives to physician Activities like greetings on birthdays Publications in medical journals Sponsorship for conferences Drug samples Information available on the website MRs provides accurate information about new medications Table Top in Chamber Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Naming of Factors After factors have been extracted, the subsequent job of the researcher was to infer and tagging of factors. This is completed by the procedure of identifying the factors that are linked with which of the original variables. This was done through the rotated component matrix. The rotated component matrix provides the loadings of all variable on all of the extracted factors with loadings whose values are between 0 and 1.Value near to 1 correspond to high loadings and those near to 0, correspond to low loadings. The purpose of this action is to locate high loadings of every pharmaceutical promotional tool or approach (variable) on every extracted factor. Table 5: Naming of Factors Factor Name Item No. Promotional tools and approaches Image(F1) 1 Constant Reminder Short Product Name Name easy to pronounce Name related to molecule Mailers from pharma companies.489 Sales promotion(f2) 6 Personal gifts Literature/updates/journals Free disease detection camp Incentives to physician Activities like greetings on birthdays.616 Advertising(F3) 11 Publications in medical journals Sponsorship for conferences Drug samples Information available on the website.415 Personal Selling(F4) 15 MRs provides accurate information about new medications. Factor loading Table Top in Chamber.505
6 The first factor is Image. The rotated matrix has revealed that respondents have supposed this factor to be the most significant factor with the highest explained variance of (18.504%).The second factor is Sales promotion. This factor consists of personal gifts, Literature/updates/journals, free disease detection camp and incentives to physicians. The rotated matrix has exposed that sales promotion to be second most important message plan in pharmaceutical sales with explained variance ( %). The third factor is advertising which accounts for (9.832 %). The fourth factor is personal selling and accounts for explained variance (9.051 %). Relationship between Age and Factors To compare more than two groups mean scores on the same variable, ANOVA was used. The variable age consists of four groups such as age as years, years, years and years as per table 6. Table 7 shows perception of physician towards various kinds of promotional tools under image, sales promotion and personal selling are dependent on their Age. N Mean Table 6 :Descriptive of the Factors Std. Deviation Std. Error 95% Confidence Interval for Mean Lower Bound Upper Bound Minimum Image years years years Total Maximum Sales Promotion years years years Total Advertising years years years Total Personal Selling years years years Total
7 Table 7: ANOVA between Age and Factors ANOVA Sum of Squares df Mean Square F Sig. Image Between Groups Within Groups Total Sales Promotion Between Groups Within Groups Total Advertising Between Groups Within Groups Total Personal Selling Between Groups Within Groups Total Relationship between Ownership of the institution and Factors The variable ownership of the institution consists of two groups which are government institute and private institute as shown in Table 8.The variable Ownership of the institution in which physicians are employed manipulate the significance attached particularly advertising. For additional study, it is significant to look for t test for equality of means. Therefore, it is clear that there is a significance difference between opinion of government serving and private serving physicians in advertising (0.049) as per table 9. Table 8 : Descriptive of the factors Type of Organization N Mean Std. Deviation Std. Error Mean image Government Institute private Institute Sales Promotion Government Institute private Institute Advertising Government Institute private Institute Personal Selling Government Institute private Institute Table 9: Independent Sample Test between Ownership of the Institution and Factors 548
8 image Sales Promotion Advertising Personal Selling not not not not Levene's Test for ity of Variances F Sig. T df t-test for ity of Means Sig. (2- tailed) Mean Difference Std. Error Difference Relationship between Gender and Factors The variable gender consists of two groups which are female and male as shown in Table 10. The variable gender manipulate the significance attached particularly image and sales promotion. For additional study, it is significant to look for t test for equality of means. Therefore, it is clear that there is a significance difference between female and male physicians in image (0.021) and sales promotion (0.034) as per table Table 10: Descriptive of Factors
9 Gender N Mean Std. Deviation Std. Error Mean Image Female Sales Promotion Male Female Male Advertising Female Personal Selling Male Female Male image Sales Promotion Advertising Personal Selling 550 Table 11: Independent Samples Test between Gender and Factors Levene's Test for ity of Variances t-test for ity of Means not not not not 5. CONCLUSIONS F Sig. T df Sig. (2- tailed) Mean Difference Std. Error Difference
10 The key purposes of this study were to investigate the impact of pharmaceutical promotion tools on prescribing behaviour of physicians and deciding promotional tools which are efficient in influencing the prescribing behaviour of physicians. Factor analysis result revealed that physicians perceive different kinds of promotional tools under four factors i.e. image, sales promotion, advertising and personnel selling. The image tactic has been supposed to be the most significant factor that influences the physicians mainly while prescribing products of a particular product. It was established that perception of physicians towards this factor is reliant upon gender and age. The sales promotion strategy has been supposed to be second most significant factor.different studies have found sales promotion to be most significant factor. It was established that perception of physicians towards this factor is reliant upon gender and age. So, pharmaceutical marketers can employ the sales promotion strategies keeping in mind age and gender. The advertising strategy has been supposed to be third significant influencing factor. It was established that perception of physicians towards this factor is dependent upon ownership of the institution. The personnel s selling has been supposed to be the fourth significant factor. It was found that perception of physicians towards this factor is reliant upon age. 6. REFERENCES [1] Forder AA How best to utilize limited resources. J Hosp Infect.; 30 Suppl: [2] Kroenke K. Polypharmacy Causes, consequences, and cure. Am J Med.79 (2): [3] Fraser RC, Gosling JT Information systems for general practitioners for quality assessment: II. Information preferences of the doctors. BMJ.;291(6508): [4] Al-Faris EA, al-dayel MA Ashton C. The effect of patients' attendance rate on the consultation in a health centre in Saudi Arabia. Fam Pract.11(4): [5] Avorn J, Chen M, Hartley R Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med.73(1):4-8. [6] Gitanjali B, Shashindran CH, Tripathi KD, Sethuraman KR1997. Are drug advertisements in Indian edition of BMJ unethical? BMJ. Aug 23;315(7106):459. [7] Waheed Abdul Kareem, Jaleel Mohammad, Laeequddin Mohammad, Prescription Loyalty Behaviour of Physicians: An Empirical Study in India, International Journal Of Pharmaceutical and Healthcare Marketing, 5(4), 2007, [8] Taneja G Impact of Pharmaceutical Industry Promotion Mix on Doctors Prescribing Behaviour, Asia-Pacific Business Review, 4, [9] SHAMIMULHAQ, S., RAHEEM, A. R., NAWAZ, A., KHOSO, I. & VISHNU, P Factors Influencing Prescription Behavior of Physicians. The Pharma Innovation Journal, ISSN, [10] Indian pharmaceutical industry report, Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, Government of India ( [11] Kerr SJ, Mant A, Horn FE 2003, McGeechan K, Sayer GP. Lessons from early large-scale adoption of celecoxib and rofecoxib by Australian general practitioners. Med J Aust.; 179: 403_7. [12] Steinman MA, Harper GM 2007 Chren MM, Landefeld CS, Bero LA. Characteristics and impact of drug detailing for gabapentin.plos Med.; 4: e134. [13] Hawkes N GlaxoSmithKline pays $3bn to settle dispute over rosiglitazone and other drugs. BMJ; 343: d
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