Background
Methods
Eligibility criteria
-
Type of study design: quantitative design (e.g., survey study) and qualitative design (e.g., focus group, interviews, semi-structured interviews);
-
Types of participants: physicians practicing in low or middle-income countries (LMIC). We used the World Bank income classification of countries’ income level;
-
Types of interactions: any form of interaction between physicians and pharmaceutical companies or PCRs (e.g., gifts, meeting with representatives of drug companies or medical/surgical device manufacturers; receiving free drug samples, industry-provided meals; pharmaceutical-funded research; pharmaceutical-sponsored continuous medical education including travel funding; consultancy; stock ownership);
-
Types of outcomes: for the purpose of this study, we used the following classification [13]:
-
◦
Knowledge (e.g., related to the extent of the interaction between physicians and pharmaceutical companies); -
◦
Beliefs: (e.g., perceptions of the effect of the interaction on quality of patient care); -
◦
Attitude: (e.g., toward the appropriateness and acceptability of the interaction).
Search strategy
Selection of studies
Data collection
Assessment of methodological features of included studies
Data analysis and synthesis
Results
Results of the search
Study ID Study design | Participants and setting | Type of interaction studied | Sampling and response rate | Validity of tool; pilot testing | Results |
---|---|---|---|---|---|
Al Areefi 2013 Study 1 [15] • Semi-structured interview Study 2 [14] • In-depth interview | Study 1 & 2 • Physicians from private and public hospitals (N = 32) • Sana’a, Yemen • May-July 2009 | Study 1 • Relationship with PCR • Frequency of PCR visits • PCR marketing activity Study 2 • Interaction between PCRs and physicians • Physicians’ attitudes toward these interactions and the PCRs • Reasons for accepting the PCRs’ visits | • Sample size calculation (both studies): not reported • Sampling frame (both studies): bot reported • Sampling method (both studies): purposeful sampling • Response rate (both studies): 100 % | Both studies • Interview guide developed through a literature review, then pilot tested with 3 physicians | Study 1 • Percentage of participants reporting the following as important factors in prescribing a specific drug: relationship with PCR (9 %), frequency of PCR visits (34 %), PCR marketing activity (13 %). Study 2 • Most physicians thought they were immune from being influenced by their interactions with PCRs. • Physicians accept a PCR’s visit because of the beneficial patronage or the financial support provided by the PCRs. • Physicians recognize the professional authority of PCRs as information providers. • Physicians considered accepting the PCR’s visit was their moral duty. • Participants still doubt the role of representatives, with some accusing them of creating problems, harming the ethical reputation of the profession and harming the patients’ welfare |
Alssageer 2013 [16] • Self-administered anonymous questionnaire | • Doctors from selected public and private practice settings (N = 608) • Libya • August-October 2010 | • Gifts received from PCRs (e.g., printed materials, simple gifts or drug samples | • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: convenience sampling • Response rate: 61 % | • Questionnaire developed based on previous published studies | • Perceived benefits from interactions with PCRs: receiving new information about products (95 % approved), invitations to conferences (35 % approved) and receipt of gifts (22 % approved). Attitudes towards accepting PCR gifts: 25 % totally disapproved; 25 % clearly approved; 50 % would accept gifts in some cases. • Acceptance of gifts according to educational value: of respondents who did not disapprove of gift provision, 82 % considered educational gifts as appropriate; 49 % considered non-educational gifts as appropriate. Belief that pharmaceutical promotional activity decreased rational drug prescribing: 42 % disagreed; 32 % agreed; and 27 % were neutral. • Perceived impact of pharmaceutical promotion on prescribing decisions of physicians: minor (62 %); major (38 %). Perceived impact of pharmaceutical promotion on own prescribing decisions: minor (80 %); major (20 %). Perceived need to develop national policies to restrict PCR interactions with doctors: 57 %. • Awareness of guidelines regarding PCR interaction: 99 % had never read any guidelines. |
Guldal 2007 • Interview | • Specialists and general practitioners in government posts (N = 446: 24 % GPs, 42 % specialists and 35 % residents) • Turkey | • Visits by PCR (frequency, duration) • Promotional Program • Provision of drug information | • Sample size calculation: not reported • Sampling frame: list of physicians from the Ministry of Health and from the 1992 Izmir telephone directory • Sampling method: stratified random sampling • Response rate: 91 % | • Questionnaire pretested with 25 subjects | • Physicians’ expectations about promotional programs: reliable educational publications (82 %); medical equipment (57 %); free drug samples (54 %); financial support for training courses (43 %); social events (e.g., dinners, trips) (34 %); and gifts of up to $50 for private use (27 %). • Support for the prohibition of PCR visits to physicians: 54 % • Attitudes towards promotional programs: not ethical (33 %); not ethical in some aspects (36 %); ethical (20 %). • Perceived effect of advertising gifts on prescriptions: high (18 %); medium (12 %); low (44 %); no effect (27 %) • 68 % thought the information was unreliable. • 94 % pointed out the necessity for a reliable source of information other than drug companies. • 54 % approved that doctors who receive expensive advertising gifts tend to prescribe that company’s products • Public knowledge that physicians were receiving gifts and awards from drug companies did not matter for 64 % |
Loh 2007 [20] • Self-administered questionnaire | • Registered practitioners (N = 172) • Penang, Malaysia • March to May 2005 | • Pharmaceutical- sponsored continuous medical education (CME) | • Sample size calculation: not reported • Sampling frame: databases of Penang Medical Practitioners’ Society and Malaysian Medical Association (Penang branch) • Sampling method: exhaustive (all registered doctors) • Response rate: 19.5 % | • Self-developed tool: content first approved by the Committee of The Penang Medical Practitioners’ Society, reviewed by 5 clinicians in active medical service to ensure clarity and appropriateness • Pilot testing not reported | • Rated impact on clinical practice by descending order, as it relates to medical conferences: local conferences, pharmaceutical talks, internet-based medical education, conferences organized by pharmaceutical firms and overseas conferences • Rated impact on clinical practice by descending order, as it relates to pharmaceutical firms: reputation of the firm, pharmaceutical company representatives, and advertisement or announcement. |
Mikhael 2014 [21] • Self-administered questionnaire | • Specialist physicians in different areas of Baghdad governorate (N = 22) • Iraq • March to October 2013 | • Quality of promotional information that is given by MRs to physicians | • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: not reported • Response rate: 63 % | • Self-developed tool; validation not reported. Pilot testing not reported | • Information from PCRs about drug indication was perceived as good and information about drug contraindications and side effects was perceived as weak. • Academic physicians have a significantly more negative opinion than hospital physicians regarding PCRs information on drug contraindication • Only hospital physicians found that PCRs’ information are useful for them |
Oshikoya 2011 [17] • Self-administered questionnaire | • Doctors in University College Hospital teaching hospital (N = 163) • Nigeria | • Provision of drug information | • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: convenience sampling • Response rate: 41 % | • Questionnaire developed from previous studies in developed and developing countries, then piloted among 10 doctors | • Drug information was sourced from colleagues (99 %), drug reference books (97 %), PCRs (93 %), materials from drug companies (93 %), scientific papers/journals/internet (91 %), and drug promotion forum/product launches (88 %). • Perception of importance of PCR as drug information source: efficient (70 %), reliable and accurate (66 %), influences prescription behavior (72 %), useful and readily used when prescribing (69 %) • Perception of the effect of detailing by a PCR of a promoted drug: increases awareness (82 %), increases preference for prescription (60 %). |
Rajan 2008 [18] • Self administered survey questionnaire | • General practitioners and specialists from an urban town (N = 57) • India | • Provision of drug information | • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: convenience sampling • Response rate: 95 % | • Questionnaire based on theoretical model, no validation reported | • Perception that product information provided by medical representatives is biased and insufficient: 79 % |
Scheffer 2014 [22] • Structured Interview | • Physicians in Sao Paolo, Brazil (N = 300) • October 2007 to May 2009 | • Informative materials about ARVs • Visits by sales promoters and sales representatives • Inexpensive objects for the doctor’s office • Invitations to take part in continuing education courses and events Scientific journals sponsored by the laboratories | • Sample size calculation: described in detail • Sampling frame: Logistics Control System (SICLOM) of the STD, AIDS and Viral Hepatitis Department of the Ministry of Health in Sao Paolo • Sampling method: stratified random sampling • Response rate: not reported | • Validation not reported; pilot testing not reported | • Pharmaceutical companies’ actions were considered to have a strong influence (10 %), slight influence (50 %) or no influence (40 %) on physicians’ prescribing of antiretroviral. |
Siddiqi 2011 [19] • Self administered questionnaire | • General practitioners and consultants (N = 200) • Various districts of Rawalpindi division, Pakistan • January –June 2010 | • Sponsorships • Scientific promotional tools • Personal touch promotional tools Common promotional tools. | • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: “Judgmental sampling” • Response rate: 75 % | • Questionnaire was adapted from existing one | • General practitioners perceived common promotional gifts as most effective tool for changing the prescribing behavior; while sponsorship and personal touch promotional tools are considered neutral and relatively least important. • Consultants perceived scientific promotional tools as most influencing in changing prescribing behaviors in comparison with other promotional tools; while sponsorships are least important |