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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 12  |  Issue : 1  |  Page : 19-23

The impact of pharmaceutical promotion on rational prescribing and drug use in Sudan


Department of Pharmacology, Faculty of Pharmacy, National University, Khartoum, Sudan

Date of Web Publication18-May-2017

Correspondence Address:
Salah Ibrahim Kheder
Faculty of Pharmacy, National University, Khartoum
Sudan
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DOI: 10.4103/summ.summ_2_17

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  Abstract 

Background: The relationship between pharmaceutical companies and health-care professionals has become a matter of debate and criticism concerning the real objectives and the potential impact on providing ethical and professional care of medicines. The aim of this study is to investigate the influences of pharmaceutical marketing on perceptions of physicians and pharmacists on their rational prescribing and health profession. Methods: A descriptive (noninterventional study), cross-sectional survey study conducted in Khartoum State during the period of September 15, 2013 TO March 20, 2014. Questionnaire was designed for this purpose and distributed to physicians and community pharmacists on a random basis. Results: Of the 200 doctors surveyed, 77 (38.5%) were physicians and 123 (61.5%) were pharmacists. Nearly 53.8% of physicians and 44.6% of pharmacists thought that they moderately influenced personally by pharmaceutical promotion. The main factors that affecting the prescribing behavior of physicians through their practice were product safety and effectiveness, i.e., 83 (76.9%) and the frequent visits by medical representatives about 54 (50.0%). While the main factors making the pharmacists ordering the product that is they have been prescribed 85 (78.7%) and the quality of the product 68 (63.0%). Discussion: The study shows that a variety of techniques were used to influence the prescribing and use of medicines such as free medical samples, gifts, journals, and direct marketing. The key role of these techniques is to increase the number of prescriptions. However; many health professionals underestimate the effects of pharmaceutical promotion on their beliefs and professional practice and believe that they are not personally influenced by promotion. Conclusion: The current quantitative study strongly suggests that the absence of regulated pharmaceutical promotion and competition results in the negative influence in the professional behavior and thus rational prescribing and use of medicines.

Keywords: Pharmaceutical promotion, rational prescribing, rational use, Sudan


How to cite this article:
Mohammed R, Kheder SI. The impact of pharmaceutical promotion on rational prescribing and drug use in Sudan. Sudan Med Monit 2017;12:19-23

How to cite this URL:
Mohammed R, Kheder SI. The impact of pharmaceutical promotion on rational prescribing and drug use in Sudan. Sudan Med Monit [serial online] 2017 [cited 2017 Aug 16];12:19-23. Available from: http://www.sudanmedicalmonitor.org/text.asp?2017/12/1/19/206561


  Introduction Top


Pharmaceutical marketing is a unique as decision-making of buying of medicine lies in the hand of intermediate customer (doctor) rather than final customer (patient). Thus, pharmaceutical companies try to influence the customer (doctor) rather than the final customer (patient). Hence, doctors are the most important players in pharmaceutical marketing system. Doctors write the prescriptions that determined which drugs (brands) will be used by consumer (patient). Thus, influencing the doctor is a key to the pharmaceutical sales. Pharmaceutical companies try to influence prescription pattern on favor of their brands by offering various kinds of promotion inputs such as samples, gifts, travel subsidies, and sponsorships.[1]

The relationship between pharmaceutical companies and health-care professionals has become a matter of debate and criticism concerning the real objectives and the potential impact on providing ethical and professional care of medicines.[2],[3] The ethical criteria for medicinal drug promotion set a standard to support and encourage the improvement of health care through the rational use of medicinal drugs by encouraging the appropriate use of pharmaceutical products by presenting them objectively and without exaggerating their properties.[4] If promotion leads to better prescribing, more rational use of medications or improved cost-effectiveness, then there would be no concern. While the evidence is not conclusive, what are all points in the direction of a strong association between reliance on promotion and less appropriate overall use of prescriptions.[5]

In Sudan, a decree for drug promotion regulation is initiated with promulgation of advertising rules by National Medicines and Poisons Board. However, there are no mechanisms to monitor the drug promotional campaign by pharmaceutical in companies in Sudan, despite the fact that there is enough evidence that the rational drug utilization problems increasingly encountered due to unethical practices of pharmaceutical promotion.[6],[7]

Market research is one tool to monitor consequences of drug promotion and to explore casual relationships between promotion and prescribing and rational drug use of medicines in developing countries. Market research is a process of gathering information to help and make informed decisions about the market business. There are mainly two kinds of research methods: qualitative market research and quantitative market research. Qualitative research is a set of research techniques used in marketing and social sciences, in which data are obtained from relatively small groups of respondents and not analyzed with statistical analysis. This differentiates it from quantities research, in which a large group of respondents provides data that statistically analyzed.

Our study is quantitative market research purposed to investigate the influences of pharmaceutical marketing on perceptions of physicians and pharmacists on their rational prescribing and health profession.


  Methods Top


This was descriptive (noninterventional study) cross-sectional survey study conducted in Khartoum State. Two sets of questionnaires were designed for this purpose and distributed to two targeted groups one for physicians in public and private sectors, and the second for community pharmacists on a random basis during the period of September 15, 2013 TO March 20, 2014. Data were collected from 200 respondents, 77 physicians of different professions, and 123 community pharmacists.

Questionnaire for physicians and pharmacists contained thirty questions divided into four sections, Section A composed of eight questions about demographic data, Section B composed of ten questions about the promotional techniques that influences the prescribing/dispensing of medicines, Section C composed of seven questions about the reasons of brand shifting among prescribers and dispensers, and Section D about main source of information and knowledge among five options. Sections B, C, and D were Likert-type scale. Data were entered into Statistical Package for the Social Sciences version 16 SPSS Inc., 233s. (Wacker Drive Chicago, IL 60606-6412 USA) and descriptive analysis was conducted.


  Results Top


Of the 200 doctors surveyed, 77 (38.5%) were physicians and 123 (61.5%) were pharmacists. Majority of them (72%) were female and most of the respondents practicing their work in private health facilities rather than public facilities (125 vs. 75). Higher percent of age was (<30) reflecting younger health-care providers, i.e., 158 (79.4%), thus not married. Different health-care providers had been surveyed, and most of them (91%) graduated from Sudan medical schools and 79.4% (158) practicing their jobs between 1 and 5 years.

Physicians agreed that the most techniques affecting their prescribing behavior were continuous medical education and authentic information (78.2%), followed by advertisement, journals and direct marketing (60.2%), the free samples (57.7%), the public relations as lunch meetings and sponsorship for the conferences (46.2%), and gifts (44.9%). Nearly 53.8% thought that they influenced personally by pharmaceutical promotion, while 71.8% of them thought that their other collogues influenced by pharmaceutical promotion. Furthermore, 53.8% of physicians thought that they were moderately influenced by medical representatives, whereas 55.10% thought that the medical representative moderately influences the prescribing of other physicians.

On the other hand, pharmacists also agreed that the most techniques affecting their dispensing behavior were continuous medical education and authentic information (76.1% and 72%, respectively), followed by advertisement, journals, and direct marketing (56.4%), the free samples and public relations as lunch meetings and sponsorship for the conferences (52.2%), and gifts (40.5%). Nearly 49.6% thought that they influenced personally by pharmaceutical promotion, whereas 63.1% of them thought that their other collogues influenced by pharmaceutical promotion. Furthermore, 44.6% of pharmacists thought that they were moderately influenced by medical representatives, whereas 47.9% thought that the medical representative moderately influences the prescribing of other pharmacists.

[Table 1] shows that the main reason for brand shifting among physicians and brand substitution among pharmacists was the price. Other reasons were therapeutic effectiveness, availability, and affordability of shifted or substituted brand to the patient.
Table 1: Reasons for brand shifting among physician and brand substitution among pharmacists

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The trade name, indications, dose, and generic name were almost always mentioned as products attributes as compared to drug interactions, contraindications, and precautions to the doctors [Figure 1].
Figure 1:The frequency of product attributes promoted to the doctors by medical representatives

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[Table 2] and [Table 3] summarize that the factors drives physicians in prescribing decision and pharmacists in ordering the product. The main factors that affecting the prescribing behavior of physicians through their practice were product safety and effectiveness, i.e. 83 (76.9%) and the frequent visits by medical rep about 54 (50.0%). While the main factors making the pharmacists ordering the product that is they have been prescribed 85 (78.7%) and the quality of the product 68 (63.0%).
Table 2: Factors affecting the prescribing behavior of physicians

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Table 3: Factors affecting the pharmacist in ordering a product

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The sources of information for updating doctors knowledge were conferences and continuous educational programs 72 (92%), journals and textbooks 66 (86%), and internet 63 (81%). The sources of information for updating pharmacists knowledge were internet 94 (78%) and conferences and continuous educational programs 89 (74%).


  Discussion Top


Many pharmaceutical promotional factors influenced the rational prescribing and dispensing of medicines by physicians and pharmacists, respectively. However, each professional has own agenda, oftentimes creates a conflict of interest. Conflicts of interest can arise from financial ties between profession and pharmaceutical company. Such ties include honorariums for writing or selling a company's product, conference sponsorships, and the supporting of scientific events.

Our study shows that a variety of techniques were used to influence the prescribing and use of medicines such as free medical samples, gifts, journals, and direct marketing. The key role of these techniques is to increase the number of prescriptions. Half and more than half of the health professionals agreed that most of the techniques used by pharmaceutical companies affecting their prescription and dispensing behavior. Free samples and gifts' effect in influencing the prescribing behavior of doctors is very well documented.[8],[9],[10] However, many health professionals underestimate the effects of pharmaceutical promotion on their beliefs and professional practice and believe that they are not personally influenced by promotion (physicians 53.8% and pharmacists 49.6%), but that their colloquies are affected (physicians 71.8% and pharmacists 63.1%), similar results were obtained by Steinman et al.[11] Psychologists have found that it is normal for people to believe that only other people are vulnerable to being misled by promotional techniques. This called the illusion of unique invulnerability.[12]

More than half of physicians (53.8%) and less than half of pharmacists (44.6%) thought that they were moderately influenced by medical representatives. Many observational studies have found an association between prescriber reliance on medical representatives and more frequent or lower quality prescribing.[13],[14] Furthermore, the more a prescriber has contact with medical representative, the more likely to recommend that a medicine is added to the hospital formulary.[15]

It is obvious from examining [Figure 1] that safety information is systemically ignored from medical representatives. In case of new drugs, heavy promotion leads to widespread prescribing and use before the safety profile of these products is fully understood. Newer, more expensive medicines displace older, less expensive ones without any evidence of an improvement in therapeutic outcomes. For the prescribing doctor to practice rational prescribing and the pharmacists to recommend to and advise patients on proper use of prescribed pharmaceuticals, both have to have a caliber of information that is “accurate, truthful, informative, balanced, up-to-date, capable of substantiation, and in good taste.”[16]


  Conclusion Top


The current quantitative study strongly suggests that the absence of regulated pharmaceutical promotion and competition results in the negative influence in the professional behavior and thus rational prescribing and use of medicines. It also draws the attention to the current situation and consequences with the hope that it might result in the establishment of enforced regulation polices and interventions to control drug promotion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Arora U, Taneja G. An analytical study of doctors behavior towards marketing of pharmaceutical products. Indian J Mark 2006;36:10-3.  Back to cited text no. 1
    
2.
Norris P, Hexheimer A, Lexchin J. Drug promotion: What we know, what we have to learn. Amsterdam: World Health Organization and Health Action International; 2005.  Back to cited text no. 2
    
3.
Wazana A, Primeau F. Ethical considerations in the relationship between physicians and the pharmaceutical industry. Psychiatr Clin North Am 2002;25:647-63, viii.  Back to cited text no. 3
[PUBMED]    
4.
WHO. Ethical criteria. Essential Drug Monitor. Geneva: World Health Organization; 1988.  Back to cited text no. 4
    
5.
Wazana A. Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA 2000;283:373-80.  Back to cited text no. 5
[PUBMED]    
6.
Idris KM, Yousif MA, Mustafa AF. Influence of pharmaceutical industry's promotion on the doctors' prescribing patterns in Sudan. J Med Use Dev Ctries 2009;1:3-13.  Back to cited text no. 6
    
7.
Idris KM, Mustafa AF, Yousif MA. Pharmaceutical representatives' beliefs and practices about their professional practice: A study in Sudan. East Mediterr Health J 2012;18:821-6.  Back to cited text no. 7
    
8.
Levin A. Sample availability may affect resident medical choice. Psychiatr News 2005;40:28.  Back to cited text no. 8
    
9.
McLean B. Drug gifts influence denied. Australian Doctor 2002; 15:11.  Back to cited text no. 9
    
10.
Steinman MA. Gifts to physicians in consumers marketing era. JAMA 2000;284:2243.  Back to cited text no. 10
    
11.
Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: Attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 2001;110:551-7.  Back to cited text no. 11
    
12.
Sagarin BJ, Cialdini RB, Rice WE, Serna SB. Dispelling the illusion of invulnerability: The motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol 2002;83:526-41.  Back to cited text no. 12
    
13.
Steinman MA, Harper GM, Chren MM, Landefeld CS, Bero LA. Characteristics and impact of drug detailing for gabapentin. PLoS Med 2007;4:e134.  Back to cited text no. 13
    
14.
Muijrers PE, Grol RP, Sijbrandij J, Janknegt R, Knottnerus JA. Differences in prescribing between GPs: Impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract 2005;22:624-30.  Back to cited text no. 14
    
15.
Chren MM, Landefeld CS. Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary. JAMA 1994;271:684-9.  Back to cited text no. 15
    
16.
World Health Organization. Ethical Criteria for Medicinal Drug Promotion. Geneva: World Health Organization; 1988.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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