Journal of Pharmaceutical Marketing & Management

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Pharmacists' Brand Recommendations of

Nonprescription Analgesics for a Simple, Tension,
and Migraine Headache

Sylvia Roins, Shalom I. Benrimoj, Peter R. Carroll & Lester W. Johnson

To cite this article: Sylvia Roins, Shalom I. Benrimoj, Peter R. Carroll & Lester W. Johnson (1999)
Pharmacists' Brand Recommendations of Nonprescription Analgesics for a Simple, Tension,
and Migraine Headache, Journal of Pharmaceutical Marketing & Management, 13:1, 27-49, DOI:
10.3109/J058v13n01_04

To link to this article: https://doi.org/10.3109/J058v13n01_04

Published online: 04 Dec 2011.

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 Pharmacists’ Brand Recommendations
of Nonprescription Analgesics
for a Simple, Tension,
and Migraine Headache
Sylvia Roins
Shalom I. Benrimoj
Peter R. Carroll
Lester W. Johnson
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ABSTRACT. Pharmacists are considered to be vital in the area of

nonprescription medication. The objective of this study was to deter-
mine the attributes and pharmacist characteristics that influence phar-
macists’ brand recommendation of a nonprescription analgesic for an
adult with a simple, tension, or migraine headache. The main question-
naire was mailed to 1,500 randomly selected Australian community
pharmacies and resulted in a 68.3% usable response rate. Principal
components analysis with varimax rotation was employed. Factor
scores were calculated and used along with some demographic details
as explanatory variables in a technique called discrete choice modeling.
The probability of pharmacists recommending particular analgesic
brands for the three types of headaches was significantly influenced by
external factors and pharmacist characteristics. External factors
included economic (p < 0.05), brand and professional (p < 0.01), cus-
tomer (p < 0.05), company (p < 0.05), and new product (p < 0.05)
influences. Characteristics of the pharmacist included pharmacist’s
position in the pharmacy (p < 0.05); the number of hours per week
pharmacist works in community pharmacy (p < 0.05); the percentage of

Sylvia Roins, Ph.D., and Shalom I. Benrimoj, Ph.D., are in the Department of
Pharmacy, and Peter R. Carroll, Ph.D., is in the Department of Life Sciences, all at
the University of Sydney, NSW 2006, Australia. Lester W. Johnson, Ph.D., is Profes-
sor of Marketing, Monash Mt. Eliza Business School, P.O. Box 2224, Caulfield Jct,
VIC 3161, Australia.
A copy of the survey instrument is available from the authors upon request.
Journal of Pharmaceutical Marketing & Management, Vol. 13(1) 1999
E 1999 by The Haworth Press, Inc. All rights reserved. 27
 28 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

the pharmacy’s ordering, purchasing, and dealing of nonprescription

analgesics in which a pharmacist was involved (p < 0.05); postgraduate
qualifications (p < 0.1); year of registration (p < 0.01); and the percent-
age of the pharmacy’s recommendation of nonprescription analgesics in
which a pharmacist was involved (p < 0.01). The study has shown that
for pharmacists’ recommendations of nonprescription analgesic brands,
it was the balance between certain external factors and pharmacist char-
acteristics that was important. The technique developed allowed the re-
searcher to ascertain the likely changes in pharmacists’ recommendation
behavior following increases in importance of significant attributes.
[Article copies available for a fee from The Haworth Document Delivery Ser-
vice: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

KEYWORDS. Community pharmacist, recommendation, nonprescrip-

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tion analgesics, migraine, headache, factor analysis, discrete choice model-

ing, multinomial logit models

INTRODUCTION

The professional practice of community pharmacy has changed

greatly over the past 40 years (1). The ‘‘explosion of medical knowl-
edge and technology,’’ the growth of consumer awareness, and the
demand for consumer rights have influenced this change (1). There-
fore, over the years, it has come to be accepted by pharmacists that
their professional responsibilities go beyond the dispensary and that
their contributions to the health system must be greater than ‘‘simply
supplying drugs’’ if they are to meet the demands of a changing
community and assure the relevance of the pharmacy profession (2).
The Nuffield Report in the United Kingdom supported the extended
role of the pharmacist in health education, and the paper by Biren-
baum in the United States emphasized the importance of clinical phar-
macy (3, 4).
Regular surveys have been conducted in America by Pharmacy
Times since 1970, by American Druggist since 1972, by Market Mea-
sures since 1983, and by Drug Topics (5-8). In the United Kingdom,
studies have been conducted by Martin Hamblin Research since 1976
and by Insight Medical Research since 1983 (9, 10). The main section
of these surveys examined the details of nonprescription brands rec-
ommended within various product categories and the frequency of
pharmacists’ brand recommendations within these groups. There were
 Roins et al. 29

limited data on the reasons given for pharmacists’ choices of nonpre-

scription products. These reports provided limited information con-
cerning the methodology of the research. Therefore, despite the wide-
spread use of nonprescription medication in the population,
knowledge of how pharmacists make specific decisions on appropriate
drug product selection, as well as knowledge of the factors they con-
sider important in recommending a product, is limited. Since pharma-
cists are considered to be vital in the area of nonprescription medica-
tion, it is important to know extensive details on these issues.
Some studies conducted in the U.S., especially the study conducted
by Igboko and Thomas, and studies conducted in Australia by Emmer-
ton, Emmerton and Benrimoj, Emmerton et al., and Roins et al., iden-
tified determinant attributes in pharmacists’ nonprescription product
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recommendations (11-18). These studies supplied exploratory details

on some of the determinant attributes and provided a basis for the
current research.
Nonprescription analgesics were chosen as the product group of
interest for a number of reasons. In Australia, nonprescription analge-
sics were the highest nonprescription category by dollar value ($64.7
million), accounting for 14.7% of the total nonprescription market
(19). Furthermore, analgesics were the most widely used group of
nonprescription drugs and the most frequently sold category of non-
prescription medications (20-22). Headache was found to be the most
common pain ailment (74% of subjects) for which nonprescription
analgesics were taken (21). The growth in analgesics sales was be-
lieved to be ‘‘spurred by such factors as demographics (a growing,
aging population), economic pressures for self care, and new product
activity’’ (23). The widespread use of nonprescription analgesics
‘‘means there is a potential for misuse’’ (21).
In Australia in 1996, the pharmacist had five single-ingredient non-
prescription analgesics that he or she could recommend: paracetamol,
aspirin, ibuprofen, naproxen sodium, and mefenamic acid. Pharma-
cists could also recommend a wide range of combinations, such as
aspirin with codeine and paracetamol with codeine with or without an
antihistamine, and a vast array of nonprescription analgesic brands.
Pharmacists, therefore, have an excellent opportunity to help the con-
sumer rationally select the appropriate nonprescription analgesic and
to provide counseling for these products (24). Drug Topics reported
that the typical pharmacist made 40 recommendations in a single week
 30 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

across a wide variety of therapeutic classes (7). The research showed

that 900,000 recommendations were made weekly for general adult
analgesia (7).

OBJECTIVE

The objective of the current paper is to describe a study to deter-

mine the attributes and pharmacist characteristics that influence phar-
macists’ brand recommendations of nonprescription analgesics for
adults with simple, tension, and migraine headaches.
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METHODS

Research Techniques

The research was conducted in four stages: a qualitative stage, a

prepilot study, a pilot survey, and the main quantitative survey. The
qualitative stage involved personal in-depth interviews with 25
Sydney community pharmacists. A pilot study was then conducted on
300 randomly selected Australian community pharmacies. The main
questionnaire was mailed to 1,500 randomly selected Australian com-
munity pharmacies and resulted in a 68.3% usable response rate. From
the qualitative work, it was found that headaches--namely, simple,
tension, and migraine headaches--appeared to be the most common
pain conditions for which pharmacists recommended nonprescription
analgesics. Hence, three types of survey questionnaires were sent to
investigate simple, tension, and migraine headaches.
The sampling frame was a list of names and addresses of communi-
ty pharmacies across Australia obtained from the Health Insurance
Commission. The sampling frame was stratified by state, and propor-
tional numbers of community pharmacies in each state or territory
were selected. Systematic sampling with a random start was the sam-
pling technique employed, with every third or fourth pharmacy being
selected from the list (25). The pain condition of interest was alter-
nated among pharmacy addresses to encourage equal proportions of
responses per category (500 of each were distributed).
A technique called discrete choice modeling was used to model the
decision structures (26, 27) (Figures 1-3). In this technique, the depen-
 Roins et al. 31

FIGURE 1. Simple Headache--MNL Model for Brand.*

Treat

Panadol Own Other Panadeine Own Nurofen

(168) para para (37) para/cod (22)
brands brands brands
(30) (24)
(59)

*Numbers in parentheses represent the number of times the brand was chosen.
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FIGURE 2. Tension Headache--MNL Model for Brand.*

Treat

Panadeine Nurofen
Mersyndol Own para/ Other para/
(24) (34)
(163) cod/doxyl cod/doxyl
brands brands
(53) (62)
*Numbers in parentheses represent the number of times the brand was chosen.

FIGURE 3. Migraine Headache--MNL Model for Brand.*

Treat

Mixed Mersyndol Own para/ Other para/ Nurofen Aspirin

para/cod cod/doxyl cod/doxyl
(163) (30) brands
brands brands brands
(16) (54) (18)
(59)
*Numbers in parentheses represent the number of times the brand was chosen.
 32 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

dent variable is the result of a discrete conscious choice made by an

individual, namely, the pharmacists’ choice of a specific analgesic
brand for a patient with a particular pain condition. Discrete choice
modeling is similar to multiple regression in that there is a dependent
variable and some explanatory variables. However, in discrete choice
modeling, the dependent variable is discrete whereas in multiple re-
gression it is continuous. Thus, discrete choice modeling may be
compared to discriminant analysis in the sense that the dependent
variable is discrete. However, as stated earlier, in discrete choice mod-
eling, the dependent variable is the result of a conscious choice, unlike
the predetermined categories in discriminant analysis.
Both multiple regression and discriminant analysis rest on linear
estimation, whereas discrete choice modeling requires a nonlinear
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estimation technique called maximum likelihood. This appears to be

an advantage, given that Emmerton obtained very low R2 values using
a linear estimation technique, multiple regression, to develop models
explaining pharmacists’ preferences for specific cough and cold prod-
ucts (12). Hensher and Johnson viewed discrete choice modeling as
‘‘the use of a variety of statistical techniques to quantify in a meaning-
ful way a relationship between a discrete choice and a set of explana-
tory variables’’ (26).
Discrete choice models, such as logit choice, are the most widely
used mathematical models for making probabilistic predictions of al-
ternative choices. Binary logit models are used where the individual
has two alternatives from which to choose. In this case, where there
are more than two alternatives, a multinomial logit (MNL) model can
be used which can accommodate choice sets containing any number of
alternatives.
Survey Instrument
The survey questionnaire consisted of six sections. The sections
relevant for this paper are Sections 3, 4, and 6. Section 3 of the
questionnaire was used to determine and measure the factors impor-
tant to community pharmacists when recommending a nonprescription
analgesic brand to an adult with a simple, tension, or migraine head-
ache. A list of 47 relevant statements concerning reasons for pharma-
cists’ recommendations of the brands was developed from the qualita-
tive work and a review of the literature (9, 11-14, 16, 18, 28-31).
Pharmacists were asked to express the degree of importance by
 Roins et al. 33

marking the corresponding point on a five-point rating scale (1 = not

at all important, 5 = very important, and 3 = neutral). Rating scales are
common scales of measurement that have been shown to be adequate
in measuring an individual’s attitude toward some subject (32).
Section 4 of the questionnaire determined the actual nonprescrip-
tion analgesic brands pharmacists recommend for an adult with a
simple, tension, or migraine headache. Section 6 of the questionnaire
requested demographic details such as the pharmacists’ position in the
pharmacy, age, gender, formal pharmacy qualification(s), pharmacy
school or university attended, year of graduation, year of registration,
hours per week the pharmacist works, and number of year’s experi-
ence. Additional variables such as percentage of pharmacy’s ordering,
purchasing, and dealing of nonprescription analgesics and percentage
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of pharmacy’s recommendation of nonprescription analgesics in

which the pharmacist was involved were also requested.
Data Analysis
The data were coded and entered for analysis in SPSSr 6.1.2 for
personal computers (33). Limdep 7.0 for personal computers was
used for the discrete choice modeling analysis (34). Exploratory factor
analysis using the principal components extraction method with vari-
max rotation of the factor structure was employed on data in Section 3
of the questionnaire (35). It is a method of determining the number
and nature of the common underlying dimensions (factors) among
larger numbers of observed variables. The major steps involved in
factor analysis following the selection and measurement of a set of
variables and preparation of the correlation matrix included the extrac-
tion of a set of factors from the correlation matrix, determining the
number of factors to extract, rotating the factors to increase interpret-
ability, and then interpreting the results (35). Factor analysis was
performed primarily for three reasons: to reduce the large number of
observed variables to a smaller number of common factors, to use the
factors obtained in constructing factor scores as explanatory variables
in the utility functions of the choice models, and as a construct validity
tool. The reliability of the factors was assessed by an internal consis-
tency measure, Cronbach’s alpha (32). A score on each of the factors
was calculated for each pharmacist by using the regression factor
score method in SPSS.
Multinomial logit models for the brand choices (Figures 1-3) were
 34 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

constructed to understand pharmacists’ recommendation behavior.

The factor scores obtained from Section 3 of the questionnaire and the
demographic details were used as explanatory variables in the utility
expressions at the brand level. Given that the choice probabilities are
dependent on attributes that do not vary across alternatives, one of the
chosen analgesic brands was arbitrarily designated as the base and the
importance of the attributes on the other brands was relative to the
base brand. The MNL models used by Schmidt and Strauss to study
the determinants of occupational choice, by Robins and Spiegelman to
study the determinants of child care type, and by Taylor et al. to study
the determinants of the accounting policy choice among Australian
firms also illustrate this situation (36-38). Panadol was chosen as the
base in the brand MNL model for a simple headache (Figure 1) and
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Mersyndolr was chosen as the base in the brand MNL model for
tension and migraine headaches (Figures 2-3). Panadolr and Mersyn-
dol were logically designated as these bases because they were the
most frequently recommended by pharmacists. The coefficients asso-
ciated with each of the explanatory variables (ßs) were allowed to vary
across alternatives. The level of significance associated with the ß
coefficient is an indication of the surety of the ß coefficient value.
The rho-squared value of the model is indicative of the model’s
goodness of fit, with values between 0.2 and 0.4 considered as good
fits (26, 39). A likelihood ratio test was also produced as part of the
output (26, 27). In this case, it tested the hypothesis that the parame-
ters used in fitting the model all have a value of zero. Twice the
difference in the log likelihood values produces a 2 test statistic with
degrees of freedom equal to the difference in degrees of freedom at the
5% significance level. If the value is significantly different, then the
explanatory variables add meaning to the model and thus the parame-
ter estimate values produced by the model are significantly different
from zero.

RESULTS
Sample Characteristics
The demographic details of the pharmacists in the sample were
compared with the available Pharmacy Board data for practicing com-
munity pharmacists across Australia. Although the main study was
conducted in 1995, only the 1994 data were available from the Phar-
 Roins et al. 35

macy Boards for comparison purposes. By means of chi-square tests,

the sample was found to consist of a significantly greater number of
younger pharmacists (44 years or younger) (51.6%), pharmacists who
were owners (both sole and partner-proprietors) (69.7%), males
(72.2%), pharmacists who worked 50 hours or more per week
(49.2%), and pharmacists who graduated in 1970 or later (59.4%).
Also, the sample consisted of significantly fewer pharmacies located
in stand-alone or strip shopping centers (71.1%). These potential
biases occurred by chance, as a randomization process was used.
However, there may still be limitations in extrapolating the findings of
this research to all Australian community pharmacists.

MNL Models for Recommendation of the Brand

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Several MNL models were estimated, but only the significant ex-
planatory variables are included in the results. The significant explan-
atory variables included the factors obtained from factor analysis as
well as pharmacist characteristics. The top row lists the brand alterna-
tives in relation to Panadol (Table 1) and Mersyndol (Tables 2-3). The
values in the tables are the ß coefficients associated with each of the
explanatory variables and consequently associated with each of the
brand alternatives. In all three models (Figures 1-3) the rho-squared
values indicated good fits and the parameter estimates were signifi-
cantly different from zero (Tables 1-3), as indicated by the likelihood
ratio tests (p = 0.00000).
In interpreting the results, it should be noted that the coefficients
enable one to determine the direction of effect of a variable. Positive
coefficients imply that pharmacists were more likely to recommend
the particular brand in relation to Panadol (Table 1) or in relation to
Mersyndol (Tables 2-3) as the importance of the associated explanato-
ry variable increased. Negative coefficients imply that pharmacists
were less likely to recommend the particular brand in relation to Pan-
adol or Mersyndol as the importance of the associated explanatory
variable increased.

Simple Headache

The results showed that as the importance of economic influences

increased (such as discounts, deals, bonuses, extended credit from
pharmaceutical companies), the more likely pharmacists were to rec-
 36 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

TABLE 1. Coefficient Estimates for Pharmacists’ Brand Recommendation for

a Simple Headache.

Own Other Panadeine Own Nurofen

para para para/cod
Variable brands brands brands
Economic Influences 0.44*** 0.34 0.11 0.96*** 1 .05***
Brand/Professional Influences 0.78*** 0.94*** 0.69*** 0.82*** 0.79***
Customer Influences 0.34** 0.18 0.26 0.53** 0.58**
Company Influences 0.62*** 0.44** 0.10 0.36 0.03
1 = Partner-proprietor; 0.35 1.19* 0.17 0.37 0.44
0 = otherwise
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1 = Pharmacist in charge; 0.76 0.02 0.74 0.25 0.46

0 = otherwise
1 = Permanent Assistant; 0.82 14.27 0.15 13.83 12.89
0 = otherwise
1 = Reliever/Casual; 13.74 13.58 12.58 0.29 2.14*
0 = otherwise
Hours per week 2.23 1.76 1.82 1.76 6.12**
% Business 1.32** 0.63 0.87 0.75 1.36
Postgraduate Qualification 0.47 1.26* 0.52 10.31 1.46*

*significant at 10% level Rho-squared = 0.30

**significant at 5% level Maximum Likelihood Estimates:
***significant at 1% level Log-Likelihood 426.8367
Restricted (Slopes = 0) Log-L 609.1982
Chi-Squared (60) 364.7231
Significance Level 0.0000000
n = 340

ommend their own paracetamol and paracetamol and codeine brands

and Nurofenr relative to Panadol (Table 1). In contrast, the greater the
importance of the brand and professional influences (such as more
brand awareness, advertising to the consumer, and colleague and doc-
tor recommendation), the less likely pharmacists were to recommend
their own paracetamol brands, other paracetamol brands such as Dy-
madonr and Panamaxr, Panadeiner, their own paracetamol and co-
deine brands, or Nurofen relative to Panadol.
As the importance of customer influences increased (such as accep-
tance of the brand, feedback, and brand previously tried), the less
 Roins et al. 37

TABLE 2. Coefficient Estimates for Pharmacists’ Brand Recommendation for

a Tension Headache.

Panadeine Own Other Nurofen

para/cod/ para/cod/
doxyl doxyl
Variable brands brands
Economic Influences 0.29 0.59*** 0.52*** 0.54***
Brand/Professional Influences 0.06 0.47*** 0.83*** 0.73***
New Product Influences 0.75*** 0.36** 0.36** 0.27
1 = Partner-proprietor; 12.17 0.92** 0.25 0.57
0 = otherwise
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1 = Pharmacist in charge; 0.10 0.99* 0.23 0.65

0 = otherwise
1 = Permanent Assistant; 0.58 0.61 0.002 1.86**
0 = otherwise
1 = Reliever/Casual; 13.95 14.53 0.71 13.21
0 = otherwise
% Business 0.72 1.39** 0.12 0.15

*significant at 10% level Rho-squared = 0.26

**significant at 5% level Maximum Likelihood Estimates:
***significant at 1% level Log-Likelihood 402.2395
Restricted (Slopes = 0) Log-L 540.7711
Chi-Squared (60) 277.0633
Significance Level 0.0000000
n = 336

likely pharmacists were to recommend their own paracetamol, parace-

tamol and codeine brands, or Nurofen relative to Panadol. The greater
the importance of company influences, such as the manufacturer’s
support of educational programs and commitment to product research
and development, the more likely pharmacists were to recommend
their own paracetamol brands or other paracetamol brands relative to
Panadol.
Partner-proprietors were less likely to recommend other paracetamol
brands relative to Panadol, compared to the sole proprietor. If the phar-
macist was a reliever/casual, the more likely he or she was to recom-
mend Nurofen relative to Panadol, compared to the sole proprietor. The
greater the number of hours per week pharmacists worked, the more
likely they were to recommend Nurofen relative to Panadol.
 38 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

TABLE 3. Coefficient Estimates for Pharmacists’ Brand Recommendation for

a Migraine Headache.

Para/Cod Own Other Nurofen Aspirin

brands para/cod/ para/cod/ brands
doxyl doxyl brands
Variable brands
Economic Influences 0.03 0.41** 0.65*** 0.11 0.34
Brand/Professional 0.39 0.76*** 0.50*** 0.72*** 0.39
Influences
Customer Influences 0.38 0.11 0.43*** 0.53** 0.29
1 = Partner-proprietor; 12.03 0.22 0.71 1.46** 0.09
0 = otherwise
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1 = Pharmacist in charge; 0.88 0.14 1.19** 0.24 0.80

0 = otherwise
1 = Permanent Assistant; 0.34 0.36 0.36 1.32 0.92
0 = otherwise
1 = Reliever/Casual; 15.57 1.29 16.22 17.37 15.53
0 = otherwise
Registration Year 2.16 0.10 0.48 8.12*** 2.48
% Recommendation 0.25 2.82*** 0.23 3.65*** 1.49

**significant at 5% level Rho-squared = 0.29

***significant at 1% level Maximum Likelihood Estimates:
Log-Likelihood 431.5729
Restricted (Slopes = 0) Log-L 609.1982
Chi-Squared (60) 355.2506
Significance Level 0.0000000
n = 340

As pharmacists became more involved in the business aspects of

pharmacy (ordering, purchasing, and dealing), they were less likely to
recommend their own paracetamol brands relative to Panadol. If the
pharmacist had postgraduate qualifications, he or she was more likely
to recommend other paracetamol brands such as Dymadon and Pan-
amax, or Nurofen relative to Panadol.
Tension Headache
The greater the importance of economic influences, the more likely
pharmacists were to recommend their own paracetamol, codeine, and
 Roins et al. 39

doxylamine brands; other paracetamol, codeine, and doxylamine

brands such as Dolasedr and Fiorinalr; or Nurofen relative to Mer-
syndol (Table 2). In contrast, as the importance of brand and profes-
sional influences increased (such as more brand awareness, consumers
recognizing the brand, advertising to the consumer, and colleague and
doctor recommendation), the less likely pharmacists were to recom-
mend their own and other paracetamol, codeine, and doxylamine
brands, or Nurofen relative to Mersyndol. The greater the importance
of the new product influences, such as samples from the company,
medical advertising, and brand coming in a range of dosage forms, the
more likely pharmacists were to recommend Panadeine or their own
or other paracetamol, codeine, and doxylamine brands relative to Mer-
syndol.
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Partner-proprietors were more likely to recommend their own para-

cetamol, codeine, and doxylamine brands relative to Mersyndol,
compared to the sole proprietor. Pharmacists in charge or managers
were less likely to recommend their own paracetamol, codeine, and
doxylamine brands relative to Mersyndol, compared to the sole propri-
etor. If the pharmacist was a permanent assistant, he or she was more
likely to recommend Nurofen relative to Mersyndol, compared to the
sole proprietor. As pharmacists became more involved in the business
aspects of the pharmacy (ordering, purchasing, and dealing), they
were less likely to recommend their own paracetamol, codeine, and
doxylamine brands relative to Mersyndol.
Migraine Headache
In interpreting the results for the migraine headache scenario (Table 3),
it was found that as the importance of economic influences increased, the
more likely pharmacists were to recommend their own paracetamol,
codeine, and doxylamine brands or other paracetamol, codeine, and
doxylamine brands such as Dolased and Fiorinal relative to Mersyn-
dol. In contrast, the greater the importance of brand and professional
influences, the less likely pharmacists were to recommend their own
paracetamol, codeine, and doxylamine brands; other paracetamol, co-
deine, and doxylamine brands; or Nurofen relative to Mersyndol.
The greater the importance of the customer influences (such as
acceptance of the brand, feedback, and brand previously tried), the
less likely pharmacists were to recommend other paracetamol, co-
deine, and doxylamine brands, or Nurofen relative to Mersyndol. Part-
 40 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

ner-proprietors were less likely to recommend Nurofen relative to

Mersyndol than the sole proprietor. Pharmacists in charge or managers
were less likely to recommend other paracetamol, codeine, and doxy-
lamine brands relative to Mersyndol, compared to the sole proprietor.
Recently registered pharmacists were more likely to recommend
Nurofen relative to Mersyndol. As pharmacists became more involved
in the recommendation of nonprescription analgesics, they were less
likely to recommend their own paracetamol, codeine, and doxylamine
brands, or Nurofen relative to Mersyndol.

Comparison

The probability of pharmacists recommending particular analgesic

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brands for the three types of headaches was significantly influenced

by external factors and pharmacist characteristics. External factors
included the economic influences (simple, tension, and migraine head-
aches), brand and professional influences (simple, tension, and mi-
graine headaches), customer influences (simple and migraine head-
aches), company influences (simple headache), and new product
influences (tension headache). Characteristics of the pharmacist in-
cluded position in the pharmacy (simple, tension, and migraine head-
aches); the number of hours per week worked in community pharmacy
(simple headache); the percentage of the pharmacy’s ordering, pur-
chasing, and dealing of nonprescription analgesics in which a pharma-
cist was involved (simple and tension headaches); postgraduate quali-
fications (simple headache); year of registration (migraine headache);
and the percentage of the pharmacy’s recommendation of nonprescrip-
tion analgesics in which a pharmacist was involved (migraine head-
ache). The MNL models for recommendation of the brand for each
type of headache were of good fit as indicated by the rho-squared
values for the models and the likelihood ratio tests.

DISCUSSION AND CONCLUSIONS

It was the balance between the external factors and pharmacist

characteristics that was important for pharmacists’ recommendations
of nonprescription analgesic brands. The technique developed allowed
the researcher to ascertain the likely changes in pharmacists’ recom-
 Roins et al. 41

mendation behavior following increases in importance of significant

attributes.
The factor labeled Economic Influences was found to have a signif-
icant positive influence on pharmacists’ brand recommendation rela-
tive to Panadol (for simple headache) and Mersyndol (for tension and
migraine headaches). The greater the importance of economic in-
fluences, the more likely pharmacists were to recommend their own
brands of the same active ingredient relative to Panadol for a simple
headache and Mersyndol for a tension or migraine headache, possibly
because they may receive better margins. Additionally, customers may
come back to that pharmacy or at least an Amcal, Thrift, or Chem-
mart pharmacy (marketing group names of pharmacies all over Aus-
tralia), depending on which store brand was recommended.
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Other paracetamol, codeine, and doxylamine brands were perhaps

recommended for a tension and migraine headache, as other pharma-
ceutical companies are gaining a competitive edge and are offering
pharmacists deals. Thus, the pharmacist may recommend their prod-
ucts, which are identical to Mersyndol, because of greater profit mar-
gins and extra bonuses, discounts, and deals. Nurofen was perhaps
recommended for a simple and tension headache because it is a rela-
tively new product for pain and inflammation and there may have been
more economic incentives for its recommendation. It should be taken
into account that the brand recommendations could also be a reflection
of the financial dynamics at the time of the survey. Emmerton and
Benrimoj found that financial influences significantly explained posi-
tive preference for the single active ingredient cough suppressant
Duro-Tussr (15). Similarly, studies in America by Pharmacy Times
found financial issues such as profit, deals, markup, and stock were
reasons frequently cited by pharmacists for recommending nonpre-
scription products (28-30). Pharmaceutical companies should there-
fore continue to offer pharmacists advantageous discounts, deals, and
bonuses, particularly when there are a number of competitive brands
on the market.
For all three types of headaches, the factor labeled Brand and Pro-
fessional Influences was found to have a significant negative influence
on pharmacists’ brand recommendation relative to Panadol (for simple
headache) and Mersyndol (for tension and migraine headaches). Pos-
sible reasons for this could be that both Panadol and Mersyndol,
having been on the market for a longer time, are more well known by
 42 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

consumers. In addition, professionals, attempting to reinforce their

own images, perhaps find them easier to recommend as patients may
be more willing to accept the recommendation. Similar results were
obtained in previous research which found that advertising influences
was the only factor significantly differentiating between pharmacists’
choice of Panadol or Dymadon, both of which contain 500mg parace-
tamol, for a simple headache (17). Emmerton and Benrimoj found that
advertising influences significantly explained negative preference for
Orthoxicol Cough Suppressantr (15). This finding suggests to phar-
maceutical companies the difficulty in trying to persuade pharmacists
to recommend other brands instead of Panadol (for simple headache)
or Mersyndol (for tension or migraine headache), given that the sup-
pliers of these two leading brands have well-developed advertising
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campaigns targeted at pharmacists, doctors, and consumers. Hence,

pharmaceutical companies should concentrate on developing and im-
plementing strategies based on other factors such as economic in-
fluences (for all three types of headache), company influences (for
simple headaches), and new product influences (for tension head-
aches). Additionally, a long-term goal may be to improve the quality
of existing advertising campaigns, since these appear to be paramount
in influencing pharmacists, doctors, and consumers.
The results obtained for the economic influences and the brand and
professional influences confirm a postulate from previous research on
an adult with a simple headache (18). This postulate stated that on
evaluation of the patient and the available nonprescription analgesics,
a pharmacist concluded that if a number of products may be appropri-
ate then the effects of advertising, economic, and social influences
may become more influential (18). Advertising and social influences
(factors obtained from factor analysis) were equivalent to the brand
and professional influences in the current research in that similar
variables represented these factors. Therefore, with generically equiv-
alent brands such as own and other brands, economic influences and
brand and professional influences were found to have significant in-
fluences on pharmacists brand recommendations of nonprescription
analgesics.
The finding that the factor labeled Customer Influences made a
significant contribution to the MNL models for the simple and mi-
graine headache scenarios serves to highlight the importance of the
customer in retail pharmacy. The finding implies that the pharmaceuti-
 Roins et al. 43

cal companies supplying the two leading products designated as the

bases, namely Panadol and Mersyndol, have succeeded in gaining the
customer’s acceptance and confidence in their products. Customer
satisfaction is very important in retail pharmacy, and rather than trying
to convince the customer that other brands are equivalent or work just
as well as Panadol or Mersyndol, it is easier for the pharmacist to
recommend a brand the customer already knows.
For a simple headache, the factor labeled Company Influences was
found to have a significantly positive influence on pharmacists’ rec-
ommendation of their own and other paracetamol brands relative to
Panadol. Strategies based on attributes such as manufacturer’s support
of educational programs and commitment to research and develop-
ment should be adopted by pharmaceutical companies in promoting
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products to pharmacists. Attributes such as these may be used by

pharmaceutical companies in gaining differentiation from their op-
position, particularly in price competitive markets. Similarly, Igboko
and Thomas designated company attributes such as manufacturer’s
policy on price uniformity for independents, chains, and hospitals and
manufacturer’s returned goods policy as determinant in pharmacists’
drug product choice decisions (11). Comparably, the manufacturer’s
reputation was found by Emmerton and Benrimoj to have a positive
influence in pharmacists’ nonprescription products selection, and in
studies conducted by Pharmacy Times, a favorable company or com-
pany policy was one of the most frequently cited reasons for recom-
mending particular nonprescription products (13, 14, 28-30).
For a tension headache, the factor labeled New Product Influences
was found to have a significantly positive influence on pharmacists’
brand recommendation relative to Mersyndol. New Product Influences
represented the variables that need to be considered if a pharmaceutical
company positions a new product on the market. These variables in-
cluded providing samples, medical advertising, presenting the brand in
a range of dosage forms, being able to purchase the brand direct from
the company, and the cost for the patient. Hence, the results indicated
that if pharmaceutical companies place emphasis on these attributes,
pharmacists may be more likely to recommend other brands rather than
the leading brand Mersyndol. This can provide valuable resource mate-
rial for pharmaceutical companies designing their marketing strategies
for introducing new products on the market.
For simple, tension, and migraine headaches, the pharmacist’s posi-
 44 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

tion in the pharmacy was found to make a significant contribution to

the models. For a simple headache, partner-proprietors were less likely
to recommend other paracetamol brands relative to Panadol, possibly
because of their concern for brand profits or deals. This suggests to
pharmaceutical companies that more emphasis should be placed on
encouraging pharmacists other than partner-proprietors to recommend
their paracetamol brands instead of the most frequently recommended
Panadol. Relievers/casuals were more likely to recommend other ap-
propriate products, such as Nurofen, rather than the leading brands,
possibly because they have no particular connection to a pharmacy
other than as relievers/casuals. In contrast, previous research found
that there were no significant effects of the pharmacist’s position in the
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pharmacy on advertising influences, economic influences, product

characteristics, and social influences when recommending nonpre-
scription analgesics for a simple headache (18). However, the research
did not investigate actual brand choice and pharmacist’s position in the
pharmacy.
For a tension headache, partner-proprietors were more likely to
recommend their own paracetamol, codeine, and doxylamine brands
relative to Mersyndol, perhaps because they felt it would influence
return visits by customers. Pharmacists in charge or managers were
less likely to recommend their own paracetamol, codeine, and doxyla-
mine brands relative to Mersyndol, perhaps because they had no
vested interest in store brands as the owner(s) would have. Permanent
assistant pharmacists were more likely to recommend Nurofen relative
to Mersyndol. Reasons for this finding are unclear but suggest that
pharmaceutical companies might try influencing permanent assistant
pharmacists to recommend a nonprescription analgesic other than
Mersyndol.
For a migraine headache, partner-proprietors were less likely to
recommend Nurofen relative to Mersyndol, possibly because Mersyn-
dol has been positioned into this area of the market and the shelves
have been well stocked due to consumer demand. Pharmacists in
charge or managers were less likely to recommend other paracetamol,
codeine, and doxylamine brands relative to Mersyndol, again because
there may be more Mersyndol in stock and because it is a brand that is
easily recommended to and accepted by patients for migraine head-
aches.
 Roins et al. 45

The greater pharmacists’ involvement in the business aspects of

pharmacy (% business), the less likely they were to recommend their
own brands relative to Panadol (for a simple headache) or Mersyndol
(for a tension headache), as these pharmacists may have greater expo-
sure to the deals, bonuses, and discounts, for example, from the major
pharmaceutical companies. At the same time, due to patient demand,
pharmacists may have more Panadol and Mersyndol in stock. For a
migraine headache, the greater the involvement of pharmacists in the
recommendation of nonprescription analgesics, the less likely they
were to recommend their own paracetamol, codeine, and doxylamine
brands, or Nurofen, relative to Mersyndol. Reasons for this finding
could be because it is easier to recommend to customers who are
familiar with leading brands than to convince customers that other
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brands work just as well, especially when pharmacists are heavily

involved in making recommendations to many customers. In contrast,
one might have thought that because they see a range of customers, the
more pharmacists are involved in the recommendation process, the
more likely they were to recommend different brands. However, it
may be that pharmacists select a brand they have found to be effective
for a particular condition and then consistently recommend this brand.
The number of hours per week a pharmacist worked was found to
have a significantly positive influence on pharmacists’ recommenda-
tion of Nurofen relative to Panadol for a simple headache. As pharma-
cists work longer hours, they are more likely to see a range of patients
and are perhaps able to recommend a different product, like an
NSAID, rather than paracetamol.
Postgraduate qualifications were found to have a significantly posi-
tive influence on pharmacists’ brand recommendations for a simple
headache, possibly because pharmacists read more extensively and are
thus more likely to recommend alternative products, such as other
paracetamol brands or Nurofen, rather than the leading brands. Profes-
sional associations and educators should encourage pharmacists to
update their knowledge continually and to further their education. This
will aid in enhancing the professional image of the pharmacist and in
ensuring that pharmacists have the requisite skills for adequately rec-
ommending nonprescription products to patients. Pharmaceutical
companies might strategically market new products to pharmacists
with postgraduate qualifications. In contrast, previous research found
that pharmacist qualifications had no significant effects on advertising
 46 JOURNAL OF PHARMACEUTICAL MARKETING & MANAGEMENT

influences, economic influences, product characteristics, and social

influences in the recommendation of nonprescription analgesics for a
simple headache (18). However, the study examined comparisons be-
tween potential influences and pharmacist qualifications rather than
actual brand choice and pharmacist qualifications. Additionally, the
study by Roins et al. was conducted on a smaller sample (80 commu-
nity pharmacists in Sydney) than the current national-scale study (18).
Year of registration was found to have a significantly positive influ-
ence on pharmacists’ recommendation of Nurofen relative to Mersyn-
dol for a migraine headache, but not for a simple or tension headache.
Recently registered pharmacists are perhaps more seriously consider-
ing product formulation appropriateness that reflects their recent
education. Thus, they are perhaps more willing to explain to custom-
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ers that these products contain the same effective active ingredients as
the leading brands. Since age and registration year were highly corre-
lated (r = --0.96, p = 0.000), there are similarities to the study con-
ducted by Emmerton and Benrimoj (15). In that study, positive prefer-
ence for the multi-ingredient product Orthoxicol Cough Suppressant
was significantly explained by age of the pharmacist, and negative
preference for the single-ingredient cough suppressant Duro-Tuss was
significantly explained by age of the pharmacist. Pharmacists aged
41-60 years preferred the multi-ingredient product Orthoxicol Cough
Suppressant, while pharmacists aged 21-40 years preferred the single-
ingredient product Duro-Tuss. In comparison, Igboko and Thomas
found a significant relationship between date of licensure and price in
the multivariate analysis of variance models, with more recently li-
censed (registered)--and hence younger--pharmacists having higher
scores for price (11).
Some continuing education programs need to be targeted at older
pharmacists in efforts to broaden their knowledge of drugs and drug
choices when recommending nonprescription products. In this study,
recently registered (younger) pharmacists were more likely to recom-
mend Nurofen relative to Mersyndol for a migraine headache. This
suggests that pharmaceutical companies should promote their new
products to recently registered pharmacists in order to be introduced
quicker.
It should be noted that the size of a coefficient for one brand relative
to the coefficient of another brand for the same explanatory variable
gives an indication of the odds of pharmacists recommending one
 Roins et al. 47

brand over another. However, more useful details on the importance of

the size of individual attributes on probabilities of pharmacists’ brand
choices can be obtained from measures of elasticities. Elasticity values
can provide information on the probability of a pharmacist choosing a
particular brand with respect to a 1% change in an attribute (explana-
tory variable) in the utility function of that brand (direct elasticity) or
in a competing brand (cross-elasticity).
The study provides insight into how community pharmacists think
and their criteria for selecting from among alternative nonprescription
analgesics. Professional associations can use this knowledge in struc-
turing continuing education programs and in providing educators with
valuable information for developing and improving undergraduate
courses. For pharmaceutical companies, this study provides valuable
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material in designing pharmacy-oriented marketing strategies. The

professional responsibility of the community pharmacist is vital to the
image of the profession.
RECEIVED: November 17, 1997
REVIEWED: January 21, 1998
ACCEPTED: March 4, 1998

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