A survey of german physicians in private practice about contacts with pharmaceutical sales representatives

Japanese physicians' perceptions of conflicts of interest with pharmaceutical companies: Estimating two different questioning approaches

Despite being one of the world's largest pharmaceutical markets, interactions between Japanese physicians and pharmaceutical companies often remain opaque. Importantly, potential conflicts of interest associated with these interactions can compromise patient care and increase costs. We conducted an online survey of Japanese physicians to elucidate perspectives on pharmaceutical company promotional activities and how these influence physician prescribing patterns. Anticipating that physicians might downplay their reliance on, or the value of, pharmaceutical company-provided information, the survey incorporated a direct questioning method and an unmatched count technique (UCT) to identify hidden perceptions on factors likely to influence prescribing. Overall, 1080 eligible physicians participated. Of these, 105 (9.7%) self-identified as hospital directors or managers. Surprisingly, nearly twice as many participants responding to direct questioning (18.9%) versus those responding to the UCT (10.1%) asserted that information provided by pharmaceutical companies was important when prescribing medicine. Hospital directors or managers (adjusted odds ratio [adjOR] 2.56, 95% confidence interval [95% CI]: 1.00-6.54, reference = physician without title) and frequent interactions with pharmaceutical sales representatives (adjOR 5.96, 95% CI: 1.88-18.9, reference = rare interaction) significantly valued the information from sales representatives and sponsored lectures when considering prescribing decisions. Additionally, 77.1% of respondents believed that sales representatives provide fair, neutral, or relatively honest and unbiased information about their products. Few Japanese physicians acknowledged the influence of industry-provided information on prescribing patterns. Our study uniquely applies two distinct question formats, providing a novel approach to understanding the depth of physician-industry relationships and the effectiveness of various survey methodologies.

Pharmaceutical brochures in Lebanon: do they meet WHO recommendations?

BACKGROUND

Drug promoting brochures can influence physicians prescription patterns. The validity of the info presented in these brochures is of major importance. World Health Organization (WHO) issued criteria to guarantee validity, equity and ethical presentation of data in medical brochures. This study aims to evaluate the quality and the validity of information presented in the pharmaceutical brochures distributed among family physicians in Lebanon.

METHODS

Pharmaceutical brochures were randomly collected at the family medicine center in Hôtel Dieu de France hospital in Beirut - Lebanon. These brochures were evaluated in reference to the WHO ethical criteria for medicinal drug promotion and on guidelines for quality assurance of the graphs, references, texts and illustrations.

RESULTS

Among the 60 brochures collected, only 4 fulfilled all the WHO ethical criteria, and 24 presented less than half the required criteria. Information concerning the drug safety are the least mentioned. Only 11.8% of the presented graphs are based on studies of high methodological level. Half of the brochures presented necessary information to identify studies references which are not always retrievable. Texts present mainly brand names instead of generic names and emphasize on information reflecting the drug efficacy.

CONCLUSION

The pharmaceutical brochures in this study presented incomplete or invalid information. Prescribing physicians should be aware of the claims found in the brochures distributed by pharmaceutical companies and should be familiar with the principles of the evidence-based medicine to be able to critically appraise the validity of the reference studies and avoid the pitfalls in graphs reading.

Challenges and opportunities for general practice specific CME in Europe - a narrative review of seven countries

BACKGROUND

Several changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development.

METHODS

Narrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation.

RESULTS

General practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented.

CONCLUSIONS

Independent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.

Views and Perceptions of Medical Representatives and Physicians about the Role of Medical Representatives and Pharmaceutical Advertisement in Saudi Arabia - A Pilot Study

Objective

Medical representatives (MRs) frequently interact with physicians who may have different perceptions about and expectations from product promotional activities by pharmaceutical companies, especially through MRs. This can affect their prescribing practice. We explored the views and perceptions of MRs and physicians about the role of MRs and pharmaceutical advertisements in Saudi Arabia.

Methods

Semi-structured interviews were conducted virtually through the ZOOM application with five MRs and five physicians from July to October 2022. The participants were recruited from the Makkah region in Saudi Arabia on a convenience sampling basis and through the snowballing method. The interviews were recorded with the consent of the participants, transcribed verbatim, and thematically analyzed.

Findings

Data saturation was found to be achieved with four interviews from each group of participants. Thematic analysis generated 338 codes which were categorized into 31 subthemes. These subthemes were further categorized into 11 overarching themes: "MR daily work," "Role of MRs in healthcare and their future," "Value of MRs in healthcare," "Pros and cons of the MR career," "MRs in the COVID-19 pandemic," "Differences between the pharmaceutical companies," "Goods and not-so-goods about the MRs," "Suggestions provided by physicians for MRs and pharmaceutical companies," "Marketing strategies of different pharmaceutical companies," "Experience of MRs" and "Support provided by pharmaceutical companies."

Conclusion

Our pilot study sheds light on the role of MRs and pharmaceutical advertisement from MRs' and physicians perspectives. Several recommendations can be drawn from our findings to make the interactions between MRs and physicians more effective and improve pharmaceutical advertisement, prescribing practices, and patient care.

Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space

Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies.

Regional differences in general practitioners' behaviours regarding influenza vaccination: a cross-sectional study

BACKGROUND

The World Health Organization recommends vaccination rates of 75% against seasonal influenza for patients over 65 years old. In the 2013/2014 season, the German vaccination rates ranged between 14 and 65%. This study aimed to compare the attitudes, personal characteristics and vaccination behaviours of general practitioners (GPs) in regions with high and low vaccination rates in Germany.

METHODS

In May 2016, a questionnaire was sent to 1594 GPs practising in 16 districts with the highest and the lowest vaccination rates in Western and Eastern Germany as described by the Central Research Institute of Ambulatory Health Care in Germany for the 2013/2014 season. Descriptive statistics and multiple regression analyses were computed to identify potential factors associated with high vaccination rates.

RESULTS

A total response rate of 32% (515/1594 participants) was observed in the study. GPs reported their attitudes towards vaccination in general and vaccination against influenza as mostly 'very positive' (80%, n = 352 and 65%, n = 288, respectively). GPs practising in regions with low vaccination rates reported their attitudes towards vaccinations in general (p = 0.004) and towards influenza vaccination (p = 0.001) more negatively than their colleagues from regions with high vaccination rates. Multiple logistic regression identified an increasing influence of year-dependent changing efficiency on GPs' influenza rates as the strongest factor for predicting GPs from highly vaccinating regions (OR = 4.31 [1.12-16.60]), followed by the patient's vaccination refusal despite GP advice due to already receiving a vaccination from another physician (OR = 3.20 [1.89-5.43]) and vaccination information gathering through medical colleagues (OR = 2.26 [1.19-4.29]).

CONCLUSIONS

The results of this study suggest a correlation between GPs' attitudes and regional vaccination rates. Beneath GPs' individual attitudes, the regional attitude patterns of patients, colleagues and medical assistants surrounding those GPs seem decisive and should be integrated into future campaigns to increase vaccination rates at a regional level.

Social and Behavioral Theories and Physician’s Prescription Behavior

The efficacy, safety, and cost of medication are the major concerns for a patient; thus, this research addresses factors that influence the physician’s prescription behavior. The objective of the undertaken study is the empirical testing of a novel conceptual model that was newly developed by the previous literature, which is based on behavioral and social theories. The considered model explains the association between marketing efforts, pharmacist factors, patient characteristics, and the physician’s decision to prescribe a drug. This unique model also includes the influence of cost and benefit ratio, drug characteristics, physician’s persistence, and trustworthiness as moderating variables. This model is useful for analyzing the prospects of marketing. We have collected 984 physicians’ responses from the urban centers of Pakistan through a structured questionnaire. We have used Structural equation modelling (SEM) based multivariate techniques such as exploratory and confirmatory factor analysis, and conditional process modelling to explore the direct and indirect relationship amongst the exogenous, moderating, and endogenous variables. The findings of the study demonstrated that marketing efforts, patient’s characteristics, and pharmacist factors have a positive and significant influence on the physician’s decision to prescribe medicines. The moderation analysis exhibited the significant effect of drug characteristics, cost–benefit ratio, physician’s persistence, and trustworthiness in a relationship between exogenous and endogenous variables. The results of the undertaken study are helpful for the marketers of the pharmaceutical industry to save wasteful marketing expenditures for the product portfolios, and measured variables may help to make meaningful marketing strategies for the physician’s prescription that provide optimum Returns on Investment (ROI) of their investments.

Development, implementation, and evaluation of a curriculum for medical students on conflicts of interest and communicating risk

Background: Insufficient risk competence of physicians, conflicts of interests from interactions with pharmaceutical companies, and the often distorted presentation of benefits and risks of therapies compromise the advising of patients by physicians in the framework of shared decision-making. An important cause of this is that teaching on this subject is mostly lacking, or fragmented when it does take place [1], [2], [3], [4]. Even though the German National Competence-Based Catalog of Learning Goals in Medicine defines learning goals on the topics of conflicts of interest and communication of risk, there are no classes that integrate both topics. Our goal was to develop a model curriculum to teach conflicts of interest and communication of risk that would integrate statistical know-how, communicational competency on the presentation of benefits and risks, and the meaning and management of conflicts of interest. Project Description: The development of the curriculum took place according to the six-step cycle of Kern et al [5]. An integrated curriculum was conceptualized, piloted, and adapted with the support of experts for the topics of shared decision-making, conflicts of interest, and communication of risk. The final version of the curriculum was implemented at the medical schools of Mainz and Heidelberg and evaluated by the students. Results: The final curriculum consists of 19 lesson units. The contents are the fundamentals of statistics, theory of risk communication, practical exercises on communication of risk, and the fundamentals of the mechanisms of effect of conflicts of interest, recognition of distortions in data, and introductions to professional management of conflicts of interest. The course was implemented three times at two different medical schools with a total of 32 students, and it was positively rated by most of the 27 participating students who evaluated it on the 1-6 German school grading scale (mean: 1.4; SD: 0.49; range: 1-2). Discussion: The curriculum we developed fills a gap in the current medical education. The innovative concept, which sensibly connects the transmission of theory and practice, was positively received by the students. The next steps are an evaluation of the curriculum by means of a two-center randomized study and the implementation at German and international medical schools. The process should be accompanied by continuous evaluation and further improvement.

Teaching Conflicts of Interest and Shared Decision-Making to Improve Risk Communication: a Randomized Controlled Trial

BACKGROUND

Risk communication is a core aspect of a physician's work and a fundamental prerequisite for successful shared decision-making. However, many physicians are not able to adequately communicate risks to patients due to a lack of understanding of statistics as well as inadequate management of conflicts of interest (COI).

OBJECTIVE

To evaluate the effects of an integrated curriculum encompassing COI and shared decision-making on the participants' risk communication competence, that is, their competence to advise patients on the benefits and harms of diagnostic or therapeutic interventions.

DESIGN

A rater-blind randomized controlled trial with a 30 (± 1)-week follow-up conducted from October 2016 to June 2017 at two German academic medical centers.

PARTICIPANTS

Sixty-three medical students in their fourth or fifth year.

INTERVENTIONS

Participants received either a newly developed 15-h curriculum or a course manual adapted from teaching as usual.

MAIN MEASURES

Primary outcome: change in risk communication performance in a video-observed structured clinical examination (VOSCE).

KEY RESULTS

Participants were 25.7 years old on average (SD 3.6); 73% (46/63) were female. Increase in risk communication performance was significantly higher in the intervention group with post-intervention Cohen's d of 2.35 (95% confidence interval (CI) 1.62 to 3.01, p < 0.01) and of 1.83 (CI 1.13 to 2.47, p < 0.01) 30 (± 1) weeks later. Secondary outcomes with the exception of frequency of interactions with the pharmaceutical industry also showed relevant improvements in the intervention as compared with the control group (d between 0.91 and 2.04 (p < 0.001)).

CONCLUSIONS

Our results show that an integrated curriculum encompassing COI and risk communication leads to a large and sustainable increase in risk communication performance. We interpret the large effect sizes to be a result of the integration of topics that are usually taught separately, leading to a more effective organization of knowledge.

TRIAL REGISTRATION

The trial is registered in the International Clinical Trials Registry with the trial number DRKS00010890.

US gynecologists' estimates and beliefs regarding ovarian cancer screening's effectiveness 5 years after release of the PLCO evidence

Efficient patient care requires the conscientious use of current best evidence. Such evidence on ovarian cancer screening showed that the screening has no survival benefit but considerable harms; currently no medical organization recommends it. In a cross-sectional online survey study with 401 US outpatient gynecologists we investigated whether they follow the recommendation of their medical organizations in daily practice and report estimates of ovarian cancer screening's effectiveness that approximate current best evidence (within a ± 10 percent margin of error), and if not, whether a fact box intervention summarizing current best evidence improves judgments. Depending on question, 44.6% to 96.8% reported estimates and beliefs regarding screening's effectiveness that diverged from evidence, and 57.6% reported regularly recommending the screening. Gynecologists who recommend screening overestimated the benefit and underestimated the harms more frequently. After seeing the fact box, 51.6% revised initial estimates and beliefs, and the proportion of responses approximating best evidence increased on all measures (e.g., mortality reduction: 32.9% [95% CI, 26.5 to 39.7] before intervention, 77.3% [71.0 to 82.8] after intervention). Overall, results highlight the need for intensified training programs on the interpretation of medical evidence. The provision of fact box summaries in medical journals may additionally improve the practice of evidence-based medicine.

Towards Patient-Centered Conflicts of Interest Policy

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians' medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians' reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians' professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices.

Glaucoma Medication Preferences among Glaucoma Specialists in Mexico

Aim

To determine the glaucoma specialists’ preferences for the different brands of topical glaucoma medications available in Mexico.

Materials and methods

A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice.

Results

Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists’ preferences.

Conclusion

Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option.

Clinical significance

This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition.

How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez-Salinas R, Dominguez-Dueñas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.

Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians' attitudes and prescribing habits: a systematic review

OBJECTIVES

The objective of this review is to explore interactions between physicians and the pharmaceutical industry including sales representatives and their impact on physicians' attitude and prescribing habits.

DATA SOURCES

PubMed, Embase, Cochrane Library and Google scholar electronic databases were searched from 1992 to August 2016 using free-text words and medical subject headings relevant to the topic.

STUDY SELECTION

Studies included cross-sectional studies, cohort studies, randomised trials and survey designs. Studies with narrative reviews, case reports, opinion polls and letters to the editor were excluded from data synthesis.

DATA EXTRACTION

Two reviewers independently extracted the data. Data on study design, study year, country, participant characteristics, setting and number of participants were collected.

DATA SYNTHESIS

Pharmaceutical industry and pharmaceutical sales representative (PSR) interactions influence physicians' attitudes and their prescribing behaviour and increase the number of formulary addition requests for the company's drug.

CONCLUSION

Physician-pharmaceutical industry and its sales representative's interactions and acceptance of gifts from the company's PSRs have been found to affect physicians' prescribing behaviour and are likely to contribute to irrational prescribing of the company's drug. Therefore, intervention in the form of policy implementation and education about the implications of these interactions is needed.

Interaction and medical inducement between pharmaceutical representatives and physicians: a meta-synthesis

Background

It has been proven that the interaction between pharmaceutical representatives and physicians can directly influence the latter’s prescribing behaviour. This meta-synthesis aims to explore the available studies regarding the nature of the interaction that takes place between pharmaceutical representatives and physicians. It highlights the different aspects of that interaction by investigating the reasons why these meetings happen in the first place, their benefits and drawbacks and their impact on patients’ health and, ultimately, the health of the public.

Methods

A search for published articles was conducted in April 2015. Three databases (PubMed, Ovid Medline, and ProQuest) were searched for articles published between January 2000 and April 2015. Authors worked autonomously and in pairs to select eligible articles. In this case, the meta-synthesis approach was used to develop a fuller understanding and to facilitate new knowledge by bringing together qualitative findings on physician-PR interaction. ‘Meta-synthesis’ is the process of amalgamation of a group of similar studies with the aim of developing an explanation for their findings (Walsh and Downe, J Advanc Nurs 50: 204–211, 2005). A thematic content analysis was conducted on the 15 included full text articles (qualitative and quantitative studies) whereby the original authors’ understanding of key concepts in each study was identified and listed in a summary form in the data extraction sheet under “key findings” column. These findings were then juxtaposed to identify homogeneity and dissonance (Walsh and Downe, J Advanc Nurs 50: 204–211, 2005). Homogenous findings were then coded together on a different data extraction table to form a theme.

Results

A total of 15 articles met the inclusion criteria and were included in this meta-synthesis;six from the United States, two from Libya, and one each from Turkey, Peru, India, Germany, the United Kingdom, Yemen, and Japan. Six main themes were derived from the included articles: 1-the frequency of pharmaceutical representatives’ visits, 2-the perceived ethical acceptability of the interactions between pharmaceutical representatives and physicians, 3-the attitudes held by physicians towards visits by pharmaceutical representatives, 4-their perception of the effect of such visits on prescription patterns, 5-reasons to accept or reject pharmaceutical representatives, and lastly, 6-guidelines.

Conclusions

The physicians referred to pharmaceutical representatives as efficient and convenient information resources and were willing to meet them and accept their gifts. It was also evident that most physicians believed that their prescribing would not be influenced by pharmaceutical representatives.

Electronic supplementary material

The online version of this article (doi:10.1186/s40545-016-0089-z) contains supplementary material, which is available to authorized users.

Physicians-Pharmaceutical Sales Representatives Interactions and Conflict of Interest: Challenges and Solutions

Physician-industry relationships have come a long way since serious debates began after a 1990 Senate Committee on Labor and Human Resources report on the topic. On one side, the Sun Shine Act of 2007, now a part of the Patient Protection and Affordable Care Act that mandates disclosure of payments and gifts to the physicians, has injected more transparency into the relationships, and on the other side, numerous voluntary self-regulation guidelines have been instituted to protect patients. However, despite these commendable efforts, problem persists. Taking the specific case of physician-pharmaceutical sales representative (PSR) interactions, also called as detailing, where the PSRs lobby physicians to prescribe their brand drugs while bringing them gifts on the side, an August 2016 article concluded that gifts as small as $20 are associated with higher prescribing rates. A close examination reveals the intricacies of the relationships. Though PSRs ultimately want to push their drugs, more than gifts, they also bring the ready-made synthesized knowledge about the drugs, something the busy physicians, starving for time to read the literature themselves, find hard to let go. Conscientious physicians are not unaware of the marketing tactics. And yet, physicians too are humans. It is also the nature of their job that requires an innate cognitive dissonance to be functional in medical practice, a trait that sometimes works against them in case of PSR interactions. Besides, PSRs too follow the dictates of the shareholders of their companies. Therefore, if they try to influence physicians using social psychology, it is a job they are asked to do. The complexity of relationships creates conundrums that are hard to tackle. This commentary examines various dimensions of these relationships. In the end, a few suggestions are offered as a way forward.

Professionalism perspectives among medical students of a novel medical graduate school in Malaysia

Defining professionalism in this constantly evolving world is not easy. How do you measure degrees of benevolence and compassion? If it is so obvious to our profession, what professionalism is, then why is it so difficult to teach it to medical students and residents? Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. However, medical professionalism is defined as the basis for the trust in the patient-physician relationship, caring and compassion, insight, openness, respect for patient dignity, confidentiality, autonomy, presence, altruism, and those qualities that lead to trust-competence, integrity, honesty, morality, and ethical conduct. The purpose of this study is to explore professionalism in terms of its fundamental elements among medical students of Universiti Sultan Zainal Abidin (UniSZA). This was a cross-sectional study carried out on medical students of UniSZA. The study population included preclinical and clinical medical students of UniSZA from Year I to Year V of academic session 2014/2015. The simple random sampling technique was used to select the sample. Data were collected using a validated instrument. The data were then compiled and analyzed using SPSS Version 21. Out of 165 questionnaires distributed randomly among Year I to Year V medical students of UniSZA, 144 returned, giving a response rate of 87%. Among the study participants, 38% (54) and 62% (90) were males and females, respectively. The grand total score was 170.92±19.08. A total of 166.98±20.15 and 173.49±18.09 were the total professionalism score of male and female study participants, respectively, with no statistically significant (P=0.61) differences. This study found almost similar levels of familiarity with all fundamental issues of professionalism with no statistically (P>0.05) significant differences. Medical faculty members should give more effort for the professional development of medical doctor. Henceforth, researchers believe and expect that the country will produce more rational and holistic medical doctors.

Influence of Medical Representatives on Prescribing Practices in Mekelle, Northern Ethiopia

BACKGROUND

Drug promotion by medical representatives is one of the factors that influence physicians' prescribing decisions and choice of drugs.

OBJECTIVE

To assess the influence of medical representatives on prescribing practice of physicians in health facilities, Mekelle, Northern Ethiopia.

MATERIALS AND METHODS

Facility-based cross-sectional study was conducted enrolling all physicians working in public and private health facilities. All public and private health facilities were included and similarly, all physicians rendering services in these facilities were sampled in the study. The data were collected from February to March, 2015. Data were then entered into Epidata Version 3.1 and transferred to STATA version 12 for analysis. Both bivariable and multivariable logistic regressions were used to determine predictors.

RESULTS

Of the ninety physicians approached in this study, 40 (48.2%) of the physicians believed that their prescribing decisions were influenced by visits of medical representatives (MRs). The odds of physicians who received gifts from MRs being influenced to prescribe their respective products was six times higher than those who reported not accepting any gifts [AOR = 6.56, 95% CI: 2.25, 19.13]. Stationery materials 23(35.4%) and drug samples 20(54.2%) were the commonest kinds of gifts given to physicians and face to face talking 45(54.2%) was the most frequent promotional methods. The finding of this study showed that around thirty-nine percent of MRs have had negative attitude toward competitors' product. Moreover, working in private health facility was also another predictor of influence of prescribing decision in the study area [AOR = 12.78, 95% CI: 1.31, 124.56].

CONCLUSION

Nearly half of the physicians working in Mekelle reported that their prescribing decisions were influenced by MRs in the last 12 months. Accepting gifts and working in private health facilities were predictors of influencing prescribing decisions. However, most MRs fails to provide adequate and accurate information regarding their products and they had a negative attitude towards the competitors' product(s).

Conflicts of interest and spin in reviews of psychological therapies: a systematic review

OBJECTIVE

To explore conflicts of interest (COI) and their reporting in systematic reviews of psychological therapies, and to evaluate spin in the conclusions of the reviews.

METHODS

MEDLINE and PsycINFO databases were searched for systematic reviews published between 2010 and 2013 that assessed effects of psychological therapies for anxiety, depressive or personality disorders, and included at least one randomised controlled trial. Required COI disclosure by journal, disclosed COI by review authors, and the inclusion of own primary studies by review authors were extracted. Researcher allegiance, that is, that researchers concluded favourably about the interventions they have studied, as well as spin, that is, differences between results and conclusions of the reviews, were rated by 2 independent raters.

RESULTS

936 references were retrieved, 95 reviews fulfilled eligibility criteria. 59 compared psychological therapies with other forms of psychological therapies, and 36 psychological therapies with pharmacological interventions. Financial, non-financial, and personal COI were disclosed in 22, 4 and 1 review, respectively. 2 of 86 own primary studies of review authors included in 34 reviews were disclosed by review authors. In 15 of the reviews, authors showed an allegiance effect to the evaluated psychological therapy that was never disclosed. Spin in review conclusions was found in 27 of 95 reviews. Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions (OR=8.31 (1.41 to 49.05)). Spin was related in trend to the inclusion of own primary studies in the systematic review (OR=2.08 (CI 0.83 to 5.18) p=0.11) and researcher allegiance (OR=2.63 (0.84 to 8.16) p=0.16).

CONCLUSIONS

Non-financial COI, especially the inclusion of own primary studies into reviews and researcher allegiance, are frequently seen in systematic reviews of psychological therapies and need more transparency and better management.

A study on the interactions of doctors with medical representatives of pharmaceutical companies in a Tertiary Care Teaching Hospital of South India

Background:

The promotional activities by medical representatives (MRs) of the pharmaceutical companies can impact the prescribing pattern of doctors. Hence, the interaction between doctors and the pharmaceutical industry is coming under increasing scrutiny.

Objective:

The primary objective was to assess the attitude of the doctors toward the interaction with the MRs of the pharmaceutical company. The secondary objective was to assess the awareness of the doctors about regulations governing their interaction with the pharmaceutical company.

Materials and Methods:

This was a cross-sectional study. This study was carried out using a pretested questionnaire containing 10 questions between June and September 2014. The doctors working in the Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur (Tamil Nadu) during the study period was included.

Results:

A total of 100 pretested questionnaires were distributed, and 81 doctors responded (response rate 81%). 37% doctors responded that they interacted with MR once a week whereas 25.9% told that they interact with MRs twice a month. About 69.1% doctors think that MR exaggerate the benefits of medicines and downplays the risks and contraindications of medicine(P = 0.000). 61.7% doctors think that MR has an impact on their prescribing (P = 0.000). 63% doctors stated that they had received promotional tools such as stationery items, drug sample, textbooks or journal reprints from MR in last 12 months (P = 0.0012). Unfortunately, 70.4% doctors have not read the guidelines about interacting with the pharmaceutical industry or its representative (P = 0.000).

Conclusion:

Rather than forbidding any connection between doctors and industry, it is better to establish ethical guidelines. The Medical Council of India code is a step in the right direction, but the majority of doctors in this study have not read the guidelines about interacting with the pharmaceutical industry or its representative.

Perceptions and Attitudes of Egyptian Health Professionals and Policy-Makers towards Pharmaceutical Sales Representatives and Other Promotional Activities

BACKGROUND

Pharmaceutical promotion activities in low and middle-income countries are often neither regulated nor monitored. While Egypt has the highest population and per capita use of medicines in the Arab world, we know very little about pharmaceutical companies promotional activities in the country.

AIM

To explore and analyze the perceptions of physicians towards promotional and marketing activities of pharmaceutical companies among physicians and pharmacists in Egypt.

METHODOLOGY

Perspectives of different healthcare system stakeholders were explored through semi-structured, in-depth interviews conducted in 2014 in Cairo, Egypt. Interviewees were chosen via purposive sampling and snowball technique. Each interview was recorded and transcribed. Then qualitative, thematic analysis was conducted with the help of NVIVO software.

FINDINGS

The majority of physicians and pharmacists acknowledged exposure to pharmaceutical promotion. It was commonly believed that interaction with the pharmaceutical industry is necessary and both associated risks and benefits were acknowledged. The interviewed physicians considered themselves competent enough to minimize risks and maximize benefits to their prescribing habits. Views diverged on the extent and magnitude of the risks and benefits of pharmaceutical promotion, especially in regard to the influence on patients' health.

CONCLUSIONS

Pharmaceutical promotion in Egypt is intensely directed at prescribers and dispensers. Physicians, pharmacists and policymakers expressed little skepticism to the influence of promotion towards their individual prescribing. Raising awareness of the pitfalls of pharmaceutical promotion is necessary, especially among the less experienced physicians.

Evaluating the reliability and accuracy of the promotional brochures for the generic pharmaceutical companies in Iraq using World Health Organization guidelines

BACKGROUND

Pharmaceutical industries worldwide are heavily involved in aggressive drug promotions. Physician targeted promotion through medical representatives is one of the most common tactic for drug promotion by pharmaceutical drug companies. WHO states that medical representatives to work in an ethical way should make available to prescribers and dispensers complete and unbiased information for each product discussed; therefore this study aimed to evaluate the ethics in the medical brochures of generic pharmaceutical companies that are given through medical representatives to physicians in Iraq.

MATERIALS AND METHODS

An observational, cross-sectional study was conducted in Iraq - Baghdad from February to April 2014. Promotional drug brochures were collected mainly from pharmaceutical exhibition during attendance of medical conferences that were sponsored by generic pharmaceutical companies. Evaluation of each brochure was based primarily on WHO criteria for ethical medicinal drug promotion. The availability of emotional pictures in each brochure was also examined. Furthermore, references were checked to find their retrievability, source, and authenticity of presentations.

RESULTS

Most medical brochures were for antibiotics, and drugs for cardiovascular diseases. All brochures mention drug name, with its active ingredient and indication, but there is a significant absence for drug interaction, while drug side effects and contraindications if present were written in a small font. Emotional picture presented in 70% of brochures. Reference citation was present in 72% of brochures, however only 75% of references in these brochures were correct.

CONCLUSIONS

The information that is provided in medical brochures is biased and mainly persuasive since it is mainly focusing on the positive aspect of drug therapy.

Contact between doctors and the pharmaceutical industry, their perceptions, and the effects on prescribing habits

Background

The prescribing behaviour of doctors is influenced by the pharmaceutical industry. This study investigated the extent to which contacts with pharmaceutical sales representatives (PSR) and the perception of these contacts influence prescribing habits.

Method

An online questionnaire regarding contact with PSRs and perceptions of this contact was sent to 1,388 doctors, 11.5% (n = 160) of whom completed the survey. Individual prescribing data over a year (number of prescriptions, expenditure, and daily doses) for all on-patent branded, off-patent branded, and generic drugs were obtained from the Bavarian Association of Statutory Health Insurance Physicians.

Results

84% of the doctors saw PSR at least once a week, and 14% daily. 69% accepted drug samples, 39% accepted stationery and 37% took part in sponsored continuing medical education (CME) frequently. 5 physicians (3%) accepted no benefits at all. 43% of doctors believed that they received adequate and accurate information from PSRs frequently or always and 42% believed that their prescribing habits were influenced by PSR visits occasionally or frequently. Practices that saw PSRs frequently had significantly higher total prescriptions and total daily doses (but not expenditure) than practices that were less frequently visited. Doctors who believed that they received accurate information from PSRs showed higher expenditures on off-patent branded drugs (thus available as generics) and a lower proportion of generics. The eschewal of sponsored CME was associated with a lower proportion of on patent-branded drug prescriptions, lower expenditure on off-patent branded drug prescriptions and a higher proportion of generics. Acceptance of office stationery was associated with higher daily doses.

Conclusions

Avoidance of industry-sponsored CME is associated with more rational prescribing habits. Furthermore, gift acceptance and the belief that one is receiving adequate information from a PSR are associated with changed prescribing habits. Further studies with larger sample sizes are needed.

Chronological changes in Japanese physicians' attitude and behavior concerning relationships with pharmaceutical representatives: a qualitative study

Background

Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time.

Methods and Findings

A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms.

Conclusions

Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.

Attitudes and relationship between physicians and the pharmaceutical industry in a public general hospital in Lima, Peru

Background

The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists.

Objective

To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru.

Design

Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale.

Results

155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%), promotional material (87.8%) and attending meetings in restaurants (81.8%). Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found.

Conclusions

A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received and ethically accepted benefit. The attitudes of physicians on the ethical standards of acceptance of medical samples and other benefits are closely related with their exposure to the pharmaceutical industry. Future studies could explore the motivations of physicians working in resource-poor settings to maintain a close relationship with industry.

Pharmacists' and physicians' perception and exposure to drug promotion: A Saudi study

Introduction

Drug promotion has to contribute to a more rational use of drugs. Concerns arise if promotion negatively influences prescribing/dispensing pattern. It is warranted to assess exposure and attitudes to, and acceptance of, drug promotion among pharmacists and physicians.

Methodology

Adopting a randomized, multiple site and cross-sectional survey study, questionnaires (n = 250) were completed by physicians and pharmacists to investigate the exposure, acceptance or skepticism of Saudi physicians/pharmacists to drug promotion as well as their perception of the appropriateness of gifts and to check if they had any teaching/training about dealing with medical representatives (MRs) and Pharma promotion.

Results

Significantly more pharmacists than physicians (32% vs. 23%; p < 0.05) reported being taught or educated about the ethics of drug promotion. The experience level was significantly associated with the teaching or training that the physicians and pharmacists received. Conference registration fees and drug samples were the most appropriate promotional gift for the physicians (67% and 66%, respectively; p < 0.01) whereas for pharmacists, the drug sample was considered the most suitable donation (79%). More pharmacists perceived drug companies as a useful way to gain knowledge about drugs than physicians (75% vs. 65%; p < 0.01). A higher proportion of both groups were accepting drug promotion than those skeptical about it.

Conclusion

The majority of physicians or pharmacists participating in this study have received gifts from pharmaceutical companies. The drug samples and printed educational materials are the most widely accepted gifts. Recent graduates and those with few years of experience had higher teaching/training than experienced physicians and pharmacists in pharmaceutical promotion ethics and tactics to deal with MRs. On the other hand, experienced healthcare team were more approached and targeted by pharmaceutical companies and MRs. It is highly recommended to implement courses/discussion groups on the ethical interaction between healthcare professionals and pharmaceutical companies in the curriculum of both pharmacy and medicine. Updating the physicians and pharmacists after graduation, as part of continued medical/pharmacy education, will eventually improve the healthcare professionals’ capability to act to the patients’ welfare.

Which pharmaceutical sales representatives' features do slovenian family physicians value?

INTRODUCTION

One of the key strategies for marketing new drugs to physicians is personal selling by pharmaceutical sales representatives (PSRs).

GOAL

The aim of this study was to determine which features of PSR's are most valued by Slovenian family physicians (FPs).

METHODS

We performed a cross-sectional observational postal survey in FPs. We sent the invitation for cooperation in the study to all Slovenian FPs working in family practices at the primary level of care (N = 895). Data was collected using a validated PSRs' assessment scale. It consists of 12 questions on PSRs' assessment that could be answered on a seven-point Likert scale.

RESULTS

The response rate was 27.6%. There were 174 (70.4%) of female physicians among the respondents. Average age of the respondents was 48.3 ± 9.0 years. Highly assessed PSRs' characteristics were "Provides objective product information", "Does not mislead", and "Shows good knowledge on the subject promoted". Worst rated PSRs' characteristics were "Possesses knowledge on health care system", "Same person for the product of company for a longer period of time", and "Acts friendly".

CONCLUSIONS

Slovenian FPs value PSRs' selling and communication skills and trustworthiness highly. FPs and PSRs develop a personal relationship which reflects in different perceptions of various PSRs' characteristics by FPs.

Conflicts of interest in medical school: missing policies and high need for student information at most German universities

Objectives: Medical students interact with pharmaceutical representatives already during medical school. The goal of this study was to find out:

Do policies exist at German medical faculties that govern the interactions between medical students and pharmaceutical representatives, do schools offer courses on the subject and do students attend these courses? And

What are the attitudes of medical students concerning the role of pharmaceutical companies in medical teaching?

Methods: All 36 German medical faculty deans and 1,151 medical students at eight German universities were asked to complete a questionnaire of 4 and 7 questions, respectively, regarding the above mentioned topics.

Results: 30 (83,3%) deans and 1,038 (90.3%) medical students filled in the questionnaire, respectively. According to the deans' answers, only one school had a policy concerning conflicts of interest and one had a policy governing the interactions between medical students and industry. 8 (26.7%) deans showed an interest in constructing a policy or educational an activity on this subject. 149 (14,4%) students had participated in an activity that focussed the subject of conflicts of interest and 779 (77,8%) wanted more education on the subject. 701 (73,4%) were opposed to an improvement of medical studies through financial support by pharmaceutical companies, whereas 216 (21,9%) were of the opinion that students should not meet with pharmaceutical representatives.

Conclusions: Unlike in other countries, like the US, most German medical faculties do not have policies that govern the interactions between medical students and pharmaceutical companies. Since most students want to be taught more about these interactions, the implementation of respective policies and lectures would be desirable.

Interactions between physicians and pharmaceutical sales representatives in Saudi Arabia

BACKGROUND AND OBJECTIVES

Interaction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction.

DESIGN AND SETTINGS

A cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012.

METHODS

A cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats.

RESULTS

A total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P < .001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status.

CONCLUSION

Although lower than seen in many parts of the world, a high prevalence of physician-PR inter.action in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.

Medical students' attitudes to and contact with the pharmaceutical industry: a survey at eight German university hospitals

BACKGROUND

Drug companies maintain close contact with physicians. We studied the extent to which medical students are already in contact with drug companies, and their attitudes toward them.

METHODS

An anonymous questionnaire containing 74 questions was distributed to 1151 medical students at eight German universities. 1038 (90.3%) of the questionnaires were filled out, returned, and evaluated.

RESULTS

12.1% of the students had never received any kind of gift from a drug company or participated in any drug company-sponsored event. 13.0% had received at least one sponsored lunch, and 24.6% had attended at least one sponsored lecture or CME event. 65.6% had received at least one non-informational gift, 50.8% an informational gift, 39.3% a reprint, and 8.6% a drug sample. 39.8% considered sponsored lectures informative and helpful, but simultaneously judged the presentation of content as biased. 45.6% and 49.7% of students, respectively, considered it all right to accept gifts because their influence was minimal in any case or because they considered themselves in a bad financial situation. 24.6% of the students thought gifts would influence their future prescribing behavior, while 45.1% thought gifts would influence their classmates' future prescribing behavior (p<0.001 for this difference).

CONCLUSION

Medical students have extensive contact with the pharmaceutical industry even before they are out of medical school. Therefore, the medical school curriculum should include information about the strategies drug companies use to influence physicians' prescribing behavior, so that medical students can develop an appropriately critical attitude.

Enabling factors for antibiotic prescribing for upper respiratory tract infections: perspectives of Lithuanian and Russian general practitioners

INTRODUCTION

General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries.

METHOD

Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed.

RESULTS

Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities.

CONCLUSIONS

Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician-patient level and take into account important factors in the enabling environment as well.

What do Libyan doctors perceive as the benefits, ethical issues and influences of their interactions with pharmaceutical company representatives?

Introduction

Evidence suggests that 80-90% of doctors in most countries across the world are frequently visited by pharmaceutical company representatives (PCRs). The objective of study to examine perceptions of Libyan doctors between August and October 2010, regarding the benefits, ethical issues and influences of their interactions with (PCRs).

Methods

An anonymous questionnaire was circulated to 1,000 Libyan doctors in selected public and private practice settings in Tripoli, Benghazi and Sebha.

Results

The major benefits of PCR visits reported in the 608 evaluable responses were; receiving new information about products (94.4%). The majority of doctors (75%) were not against the provision of gifts but were more comfortable if it was “cheap” (51%) and had educational value (51%). Doctors who received more printed materials, simple gifts or drug samples were less likely to disapprove of accepting gifts (p5]. Effective marketing can positively influence an individual's attitude towards a product and because there is an association between attitude, intention and behaviour [6], persuasive communication can generate a positive attitude and increase the potential for influence [7]. PCRs can accomplish behaviour change because they directly communicate with prescribers. During a visit they attempt to raise awareness of their products, provide product information and encourage a favourable attitude towards their company and product [8]. They employ verbal persuasion techniques and also provide other incentives such as gifts, free drug samples and sponsored educational events [2]. The provision of promotional gifts can be seen as a friendship building technique to reinforce the communication nexus between PCRs and doctors but it can also potentially erode professional barriers [9]. Contact between a PCR and a medical practitioner is therefore viewed by drug companies as a vital part of their marketing strategy and frequent visits, together with written promotional materials, gifts and other incentives, can help alter behaviour even if the initial attitudes towards a product were weak or unclear [10].

A survey of pharmaceutical company representative interactions with doctors in Libya

OBJECTIVES

To examine the frequency of pharmaceutical company representative (PCR) interactions with doctors in Libya and review possible associations between these interactions and the personal and practice setting characteristics of doctors.

METHOD

An anonymous survey questionnaire was circulated to 1,000 Libyan doctors in selected public and private practice settings in Tripoli, Benghazi and Sebha.

RESULTS

A questionnaire return rate of 61% (608 returned questionnaires) was achieved. Most respondents (94%) reported that they had been visited by PCRs at least 'once' in the last year. Fifty per cent of respondents met with PCRs at least once a month, and 20% at least once a week. The following characteristics were significantly associated with meeting with a representative more than once a week: age, gender (male > female), years of practice, being a specialist (other than an anaesthesiologist) or working in private practice. Ninety-one per cent of doctors reported that they had received at least one kind of relationship gift during the last year. Printed materials (79%), simple gifts (73%) and drug samples (69%) were the most common relationship products given to respondents. Reimbursements or sponsored items were reported by 33% of respondents. Physician specialists were more likely to receive drug samples or sponsored items than residents, general practitioners, anaesthesiologists or surgeons (P<0.01). Participants working in private practice alone or in both sectors were more likely to receive printed materials, simple gifts or free samples from PCRs than doctors working in the public sector (P<0.05).

CONCLUSION

Libyan doctors are frequently visited by PCRs. Doctors, working in private practice or specialist practice, are especially targeted by promotional activities. An agreed code of conduct for pharmaceutical promotion in Libya between doctors and PCRs should be created.

Remuneration for non-interventional studies--results of a survey in the pharmaceutical industry in Germany

In 2007 the Association of Research-Based Pharmaceutical Companies (vfa) published recommendations to improve the quality and transparency of non-interventional studies. These recommendations include quality assurance measures, in particular with respect to transparency as well as for the verification of the data collected in these studies. This publication presents the results of a survey on fees in non-interventional studies which was conducted within the member companies of the vfa in June 2011. These results demonstrate a consistent adherence to the statutory requirements and the implementation of the recommendations concerning the remuneration of the study centers. Depending on the indication, the number of routine doctor/patient contacts is different and associated with that number the documentation efforts vary. Accordingly, the fee varies based on the fee schedule for physicians (German: Gebührenordnung für Ärzte) by taking into account the actual efforts at the study center.