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The Impact of Pharmaceutical Promotion practices on Prescribing Behaviour

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 International Journal of Engineering Technology, Management and Applied Sciences

www.ijetmas.com May 2017, Volume 5, Issue 5, ISSN 2349-4476

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

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individual selling through medical representatives, medicines samples, physicians meetings and proceedings;
and advertisements in medical journals.
Physicians assumed that business-related sources had small effect on 68% of them whereas 54% of them
assumed that medical representatives were modestly significant in choosing prescriptions. In contrast 62%
assumed logical proof was very significant in influencing their prescribing behaviour. However, 88% of
physicians assumed 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.

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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 2016. 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 25 -35 years of age were 105(22.3%) , while 36-45 years of age of doctors were
192(40.9%), 46-55 years of age groups of doctors were 168(35.7)%, while 56 -65 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
Frequency Percentage
25 – 35 105 22.3%
36 – 45 192 40.9%
Age
46 – 55 168 35.7%
56 – 65 5 1.1%
Male 138 29.4%
Gender
Female 332 70.6%
Internal Medicine 64 13.6%
Surgery 58 12.3%
Orthopedics 50 10.6%
Pediatrics 22 4.7%
Specialty
Obstetrics/gynecology 68 14.5%
Psychiatry 2 0.4%
Ophthalmology 14 3.0%
Other 192 40.9%

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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 Approx. Chi-Square

Sphericity 1498.782

df 120
Sig. .000
As per table 2, measure of sample adequacy which are Barlett’s test of sphericity (approx Chi – Square is
1495.782, 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 50.555%. The findings were obtained through rotations with varimax and the
factor loadings greater than 0.40 were taken.
Table 3: Total Variance explained
Extraction Sums of Squared
Initial Eigenvalues Loadings Rotation Sums of Squared Loadings

% of
% of Cumulative Varianc Cumulative % of Cumulative
Component Total Variance % Total e % Total Variance %
1 3.269 20.430 20.430 3.269 20.430 20.430 2.961 18.504 18.504
2 2.425 15.159 35.590 2.425 15.159 35.590 2.107 13.168 31.673
3 1.252 7.826 43.416 1.252 7.826 43.416 1.573 9.832 41.504
4 1.142 7.139 50.555 1.142 7.139 50.555 1.448 9.051 50.555
5 .979 6.117 56.672
6 .958 5.988 62.661
7 .905 5.657 68.318
8 .792 4.951 73.269
9 .702 4.388 77.657
10 .687 4.291 81.948
11 .666 4.160 86.108
12 .588 3.676 89.784
13 .497 3.109 92.893
14 .431 2.697 95.590
15 .364 2.274 97.863
16 .342 2.137 100.000
Extraction Method: Principal Component Analysis.

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Table 4 :Rotated Component Matrixa

Component
Item No. Promotional tools and approaches 1 2 3 4
1 Constant Reminder .821
2 Short Product Name .809
3 Name easy to pronounce .755
4 Name related to molecule .752
5 Mailers from pharma companies .489
6 Personal gifts .648
7 Literature/updates/journals .609
8 Free disease detection camp .594 .355
9 Incentives to physician .521
10 Activities like greetings on birthdays .616
11 Publications in medical journals .575
12 Sponsorship for conferences .469 .556
13 Drug samples .516 .540
14 Information available on the website .403 .415 .365
15 MRs provides accurate information about new medications. .847
16 Table Top in Chamber .455 .505
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 Promotional tools and approaches Factor loading
No.
Image(F1) 1 Constant Reminder .821
2 Short Product Name .809
3 Name easy to pronounce .755
4 Name related to molecule .752
5 Mailers from pharma companies .489
Sales promotion(F2) 6 Personal gifts .648
7 Literature/updates/journals .609
8 Free disease detection camp .594
9 Incentives to physician .521
10 Activities like greetings on birthdays .616
Advertising(F3) 11 Publications in medical journals .575
12 Sponsorship for conferences .556
13 Drug samples .540
14 Information available on the website .415
Personal Selling(F4) 15 MRs provides accurate information about new
.847
medications.
16 Table Top in Chamber .505

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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 (13.168 %). 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 25 -35 years, 36 – 45 years, 46-55 years and 56 – 65 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.
Table 6 :Descriptive of the Factors
95% Confidence
Interval for Mean
Std. Std. Lower Upper
N Mean Deviation Error Bound Bound Minimum Maximum
Image 25-35 years 105 3.8724 .75860 .07403 3.7256 4.0192 1.20 5.00
36-45 years 192 3.9203 .89802 .06481 3.7925 4.0481 1.40 5.00
46 -55 years 168 3.6619 1.01815 .07855 3.5068 3.8170 1.00 5.00
56-65 5 3.1200 1.59750 .71442 1.1364 5.1036 1.40 4.60
Total 470 3.8087 .93043 .04292 3.7244 3.8931 1.00 5.00
Sales 25-35 years 105 2.2810 .80166 .07823 2.1258 2.4361 1.00 5.00
Promotion
36-45 years 192 2.5130 .91659 .06615 2.3825 2.6435 1.00 4.75
46 -55 years 168 2.4747 .84796 .06542 2.3455 2.6039 1.00 4.50
56-65 5 1.8000 .67082 .30000 .9671 2.6329 1.25 2.75
Total 470 2.4399 .87016 .04014 2.3610 2.5188 1.00 5.00
Advertising 25-35 years 105 2.6533 .78460 .07657 2.5015 2.8052 1.00 4.80
36-45 years 192 2.4323 .84258 .06081 2.3123 2.5522 1.20 4.80
46 -55 years 168 2.4762 .82703 .06381 2.3502 2.6022 1.00 4.60
56-65 5 2.2000 .98995 .44272 .9708 3.4292 1.40 3.80
Total 470 2.4949 .82814 .03820 2.4198 2.5700 1.00 4.80
Personal 25-35 years 105 3.4190 1.08558 .10594 3.2090 3.6291 1.00 5.00
Selling
36-45 years 192 3.8333 1.12368 .08109 3.6734 3.9933 1.00 5.00
46 -55 years 168 3.8750 1.01449 .07827 3.7205 4.0295 1.00 5.00
56-65 5 2.6000 .41833 .18708 2.0806 3.1194 2.00 3.00
Total 470 3.7426 1.09110 .05033 3.6437 3.8415 1.00 5.00

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Table 7: ANOVA between Age and Factors

ANOVA
Sum of Squares df Mean Square F Sig.
Image Between Groups 8.809 3 2.936 3.445 .017
Within Groups 397.205 466 .852
Total 406.014 469
Sales Promotion Between Groups 5.930 3 1.977 2.638 .049
Within Groups 349.184 466 .749
Total 355.114 469
Advertising Between Groups 3.882 3 1.294 1.898 .129
Within Groups 317.766 466 .682
Total 321.648 469
Personal Selling Between Groups 22.045 3 7.348 6.385 .000
Within Groups 536.304 466 1.151
Total 558.349 469

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 374 3.8134 .91934 .04754
private Institute 90 3.8122 .94996 .10014
Sales Promotion Government Institute 374 2.3971 .87742 .04537
private Institute 90 2.6111 .82373 .08683
Advertising Government Institute 374 2.6080 .82847 .04284
private Institute 90 2.0267 .66718 .07033
Personal Selling Government Institute 374 3.7460 1.08409 .05606
private Institute 90 3.7222 1.10695 .11668

Table 9: Independent Sample Test between Ownership of the Institution and Factors

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Levene's Test for

Equality of
Variances t-test for Equality of Means
Sig. (2- Mean Std. Error
F Sig. T df tailed) Difference Difference
image Equal
variances .401 .527 .011 462 .992 .00115 .10864
assumed
Equal
variances not .010 132.037 .992 .00115 .11085
assumed

Sales Equal
Promotion variances .430 .512 -2.102 462 .036 -.21405 .10183
assumed
Equal
variances not -2.185 141.715 .031 -.21405 .09797
assumed

Advertising Equal
variances 3.905 .049 6.190 462 .000 .58135 .09392
assumed
Equal
variances not 7.060 161.982 .000 .58135 .08235
assumed

Personal Equal
Selling variances .105 .746 .186 462 .853 .02377 .12780
assumed

Equal
variances not .184 133.132 .855 .02377 .12945
assumed

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 11.

Table 10: Descriptive of Factors

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Std.
Std. Error
Gender N Mean Deviation Mean
Image Female 138 3.6855 1.00912 .08590
Male 332 3.8599 .89229 .04897
Sales Female 138 2.2627 .78671 .06697
Promotion
Male 332 2.5136 .89339 .04903
Advertising Female 138 2.4522 .82065 .06986
Male 332 2.5127 .83182 .04565
Personal Female 138 3.5906 1.08445 .09231
Selling
Male 332 3.8057 1.08925 .05978

Table 11: Independent Samples Test between Gender and Factors

Levene's Test for
Equality of
Variances t-test for Equality of Means
Sig. (2- Mean Std. Error
F Sig. T df tailed) Difference Difference
image Equal
variances 5.363 .021 -1.856 468 .064 -.17443 .09399
assumed
Equal
variances not -1.764 230.442 .079 -.17443 .09888
assumed
Sales Equal
Promotion variances 4.513 .034 -2.868 468 .004 -.25087 .08746
assumed
Equal
variances not -3.023 288.885 .003 -.25087 .08300
assumed
Advertising Equal
variances .028 .866 -.721 468 .471 -.06048 .08392
assumed
Equal
variances not -.725 259.417 .469 -.06048 .08345
assumed
Personal Equal
Selling variances .016 .899 -1.953 468 .051 -.21514 .11018
assumed
Equal
variances not -1.956 257.267 .052 -.21514 .10998
assumed
5. CONCLUSIONS

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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.

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