Mir Monir Hossain et al. Int. Res. J. Pharm.

2013, 4 (8)
Page 112
INTERNATIONAL RESEARCH JOURNAL OF PHARMACY
www.irjponline.com ISSN 2230 8407
Research Article

ASSESSMENT OF INFLUENCING FACTORS ON PRESCRIPTION PRACTICES OF PHYSICIANS IN
BANGLADESH
Mir Monir Hossain
1
*, Sumaiya Kawsar
2
, Tasmuna Tamrin Tanmy
2
and Abu Yousuf
3

1
Assistant Professor, Department of Pharmacy, University of Science and Technology Chittagong (USTC), Foys Lake,
Chittagong, Bangladesh
2
Students of Master of Pharmacy (M. Pharm), Department of Pharmacy, University of Science and Technology Chittagong
(USTC), Foys Lake, Chittagong, Bangladesh
3
General Physician, Department of Forensic Medicine, BGC Trust Medical College, Chittagong, Bangladesh
*Corresponding Author Email: [email protected]

Article Received on: 10/06/13 Revised on: 08/07/13 Approved for publication: 11/08/13

DOI: 10.7897/2230-8407.04819
IRJP is an official publication of Moksha Publishing House. Website: www.mokshaph.com
All rights reserved.

ABSTRACT
In Bangladesh same drug molecules are sold under different brand names by different pharmaceutical companies. To persuade the physicians to prescribe their
brands pharmaceuticals engage in marketing techniques like giving samples, gifts, sponsoring travel etc. Many countries are striving to reduce the impact of
incentives on prescription behavior. This study explores the influence of factors on the prescription practices of doctors in Bangladesh. Data collection was
done by a self administered questionnaire. This document outlines the research works holds the initial research finding out the factors that literally affect the
drugs and medicines that goes written in a prescription. Five fully dedicated groups of people were engaged for conducting the survey efficiently without any
bias. The survey required four months of time to come for an end. The reflection and feedback we received from this project, is completely the picture of
whole Bangladesh.
Keywords: Prescription, physician, representatives, factors.

INTRODUCTION
Prescribing is one of the most important roles of a physician
because medication is one of the most frequent ways of
treating illness. A prescription (R
X
) is a health-care
programme that governs the plan of care for an individual
patient and is implemented by a qualified practitioner. In the
last few years the relations between the physicians and
pharmaceutical companies have received considerable
attention
1,2
. Physicians are privileged with the right of
recognizing the need of their patients and recommend
medications for the well-being of their patients. Hence, the
relation between the physician and pharmaceutical companies
may create a conflict between the ethical professional interest
of a doctor and his financial self-interest. The increase in
incentives to attract the doctors prescription behavior reflects
as a rise in the price of prescription medicines. The
pharmaceuticals resort to many ways in marketing their
product. Giving away gifts, free lunches, sponsoring
education and holidays have all been criticized as
inducements which compel a doctor to prescribe without
scientific basis
3
. A study from Canada showed that the
association with pharmaceuticals leads to less than
appropriate prescribing behavior by the doctor
4
. Many
physicians, however, do not feel that their prescriptions are
influenced by gifts and other incentives provided by
pharmaceuticals
5
. What is the ethical acceptability of
physicians receiving gifts from drug companies? Large
industry gifts are considered as inducements while small gifts
such as pens, paperweights and note pads, considered
acceptable by many. Evidence from social science research
suggests that gifts of negligible value can influence the
behavior of the recipient and the recipient may not always
realize this
6
. More than eighty percent of physicians see drug
representatives or sales personnel regularly
2
. Studies in
China
5
and Australia
7
showed that sales personnel do not
significantly affect a doctors prescription behavior. One of
the disadvantages of these studies, which depended on the
responses of the physicians, is the possibility of faking good
bias
8
which is a tendency among responders to give socially
desirable responses to questions relating to ones behavior.
These trends have raised the concern that pharmaceutical
companies might have undue influence on the prescribing
behavior of physicians. In particular, there is concern that a
significant percentage of physicians might be prescribing a
narrow range of heavily promoted drugs, or might be
exclusively prescribing branded drugs to the detriment of
patient welfare. However, empirical evidence on the
prescribing behavior of physicians and its consequences for
patients is limited. Some studies suggest that physicians
exhibit narrow prescribing behavior, particularly general
practitioners, but much of this evidence is decades old
9-13
.
More recent work finds that the prescribing patterns of
physicians are substantially more concentrated than the
aggregate market in each class and that physicians differ in
their preferred drug within a class
14,15
. There are no recently
published studies that have addressed the factors that
influence the prescription behavior of physicians in
Bangladesh. This study aims to identify the factors that
influence the prescription behavior of physicians in the
choice of brands.

MATERIALS AND METHODS
Data collection was conducted by a self administered
questionnaire. The places of Bangladesh covered under this
research were carefully selected by first identifying the places
where most patients gather for consult and treatment. Before
going into field of practice, a survey plan and schedule were
set ahead which sincerely followed and the target was
successfully accomplished. The study subjects were from two
categories: physicians and sales personnel. The sampling of
physicians was done by stratified sampling. There were two
strata of physicians: i) General practitioners (GPs), and ii)
Mir Monir Hossain et al. Int. Res. J. Pharm. 2013, 4 (8)
Page 113
Specialists physicians (those with either DM or MCh degree).
The sales personnel were also sampled similarly so that a fair
distribution of field staff, middle level managers and
supervisors were available. Five hundred (500) physicians
response were recorded. Responder physicians include both
general practitioners (GPs) as well as specialist doctors.
Among them 180 were GPs and rest 320 were specialist
doctors.

Physician
Category
Number of responders
(In total 500 responders)
Percent of
responders
General physicians
(GPs)
180 36 %
Specialist
physicians
320 64 %

A schedule was made for the convenience of meeting with
the physicians. The schedule was entirely based on the time
of availability of the physicians in hospitals, clinics and in
their private chamber. The survey was conducted between
August and November of 2012.
In the same way, we took carefully the responses of sales
representatives of renowned pharmaceutical manufacturers to
reflect the real views of prescription behavior of the
physicians. In the way of accomplishing this research work,
there were constraints like any other work. The constraints
include: lack of human resources, lack of financial resources,
time limitations and work load of physicians and obviously
lack of interest of both physicians and sales people to
response. But we tried of our best to perform our research
work smoothly and effectively.

RESULTS AND DISCUSSION
The study subjects included both physicians and sales
representatives. Five hundred (500) physicians response were
recorded. Responder physicians include both general
practitioners (GPs) as well as specialist doctors. Among them
180 were GPs and rest 320 were specialist doctors. The sales
personnel surveyed included 100 field staffs and 25
managers. The questionnaires were assessed and calculated
properly. The results can be presented by different figures
and graphs that can be discussed as follows: The majority of
doctors believed that information they receive from
prescription drug company representatives was helpful to
them, viewing the information as at least somewhat useful
and accurate. Almost all physicians received perks from the
sales representatives, with over 8 in 10 told that they received
free drug samples. The majority of physicians knew that
these drug company representatives receive information
about their prescribing practices. When presented with three
possible reactions to this profiling, physician expressed some
discomfort but told they understood why the drug companies
practiced that (61 %). However, about 7 in 100 told that they
are strongly opposed to the collection and use of this
information, while over 2 in 10 expressed the opposite view,
said that they have no problem with this practice.

Few doctors thought that, the information from drug
company representatives were very useful but the
majority believed these was at least somewhat useful
(Figure 1). In this case, 14 % of doctors told that,
informations from drug representatives were very useful,
and 72 % told these were somewhat useful.


When the physicians are asked for the accuracy of
informations provided by the drug representatives then
the majority of them believed that it the informations
were somewhat accurate (Figure 2). In this case, 74 % of
doctors told that, informations from drug representatives was
somewhat accurate and 16 % told that not very accurate.

Most physicians (84 %) told that, they received free drug
samples from a drug company representative (Figure 3).
In this case, 2 % physicians told that, they received free gifts,
5 % told they received financial incentives, 5 % responded
for meal, free tickets or free travels and 2 % told they
received other in-kind benefits.

About 53 % physicians realized that, drug industry
representatives received information about their
prescribing drugs, but around 44 % were not aware
about it (Figure 4).

When told drug companies profile to them, 27 % doctors
were most likely to say that, they were not entirely
comfortable with this, but they understood why the
companies collected the information (Figure 5). Here 61 %
of doctors chose the statement, It bothers me, but I
understand why they do it, about 7 % expressed strong
opposition to the practice, picking the statement, It is
unacceptable for them to collect and use this information
from the questionnaire.

When asked about whom physicians to expect as medical
representative, 36 % answered that, they expect
pharmacists to come while 61 % told they expect any
science graduate to approach (Figure 6).

When physicians are asked for the types of drug name
they like to prescribe then 66 % physicians told they like
to prescribe drugs in brand names and 33 % answered
that they like to write generic names of drugs in
prescription (Figure 7).

In response to the question of how many medical
promotional representatives visit physicians each day, the
answers of physicians were varied. It is best to describe
the number of medical promotional representatives in
range. The range of number of medical representatives
visited physicians was from minimum two (02)
representatives to thirty (30) at maximum.

In the case of time spared by the physicians for medical
promotional representatives, the range was from five (05)
to one hundred and twenty (120) minutes per day.

CONCLUSION
This innovative study indicates that, a number of factors
influencing the prescription habits of physicians in our
country. The perk of pharmaceutical companies now a days
have so strong impact on physicians that nearly two thirds of
the practitioners (66 %) liked to write brand name of drugs on
a prescription. This is clearly beneficial for the
pharmaceutical companies but at the end of the run it affects
the patients. People could have get treatment at lower cost if
the prescriber intend more to prescribe drugs by generic
name.
Mir Monir Hossain et al. Int. Res. J. Pharm. 2013, 4 (8)
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Figure 1: Usefulness of Information



Figure 2: Accuracy of Information



Figure 3: Perks from Companies
Mir Monir Hossain et al. Int. Res. J. Pharm. 2013, 4 (8)
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Figure 4: Information Received by Representatives Regarding their Prescribing Drugs



Figure 5: Opinion about Information Collection



Figure 6: Expected Qualification of Medical Representative

Mir Monir Hossain et al. Int. Res. J. Pharm. 2013, 4 (8)
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Figure 7: Type of Drug Name Physician Prescribe

Physicians also preferred science graduates over pharmacists
to work as medical promotional representatives, which is
totally opposite what is practiced in the developed countries.
The reason is found to be the fact that, the pharmacy
graduates are reluctant to come in this field as because of
poor remuneration in comparison to their standard. But it is
now a high time that the pharmacy graduates should come
forward to enter the field of pharmaceutical product
promotion. From the view of maximum physicians (72 %),
the informations provided by the drug companies were
somewhat useful. In practice, it was found that, the
informations those the drug companies gathered about a new
drug were often accurate in data but they also sometimes
exaggerated the informations when they presented these
before a physician. Our suggestion from this research work to
this point is that, the pharmaceutical companies should focus
more on the well being of health care system of the country
alongside their business profit. They will definitely visit the
physicians and other personnels involved in healthcare
system but at the same time they should also adopt the oath
of anti-bribery and anti-corruption as they deal with the
most delicate product of human health care.

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Cite this article as:
Mir Monir Hossain, Sumaiya Kawsar, Tasmuna Tamrin Tanmy and Abu
Yousuf. Assessment of influencing factors on prescription practices of
physicians in Bangladesh. Int. Res. J. Pharm. 2013; 4(8):112-116
http://dx.doi.org/10.7897/2230-8407.04819






Source of support: Nil, Conflict of interest: None Declared