Table 1 Characteristics and methodological features of the included studies
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 |