Pmt Project

8/6/2019 Pmt Project

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A mini dissertation

on

Sources of information for medical practitionerregarding new therapies: A perception analysis

Under the Guidance of

Dr. Manthan D. Janodia

Assistant Professor

Department of Pharmacy

Management,

MCOPS,

Manipal

Submitted By

Pankaj Pansheriya

Shripad Atale

Vivek Wadbudhe


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Contents

1.Introduction

2.Literature review

3.Objectives of the study

4.Research methodology

5.Data presentation, Analysis and Interpretation

6.Conclusion7.Recommendations

8.Bibliography


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Introduction


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Unlike other markets Pharmaceutical market is highly regulated and competitive market. It

is driven by mixture of scientific and technological approach. Unlike other industries and

markets the scenario of pharmaceutical market is totally different. In pharmaceutical

market concept of customer and consumer is different. Here medical practitioners are the

customers and patient is consumer in case of prescription drugs, while patient is customer

in case of OTC drugs. Medical representatives go to the medical practitioners as company

representative and detail their product by giving scientific information. They provide

literatures containing detailed information of product and its benefit backed by data of

clinical studies conducted by the company. The sales of the prescription drug are affected

by medical practitioners who prescribe the companys product. There are many other

sources which give information regarding new as well as existing therapies. The

perception and preference of medical practitioners about information sources is vastly

different. Each practitioner has different perception in selection of information sources.

The objective of study was to find out the perception of physician regarding source of

information for the new therapies. This study also includes the perception of medical

practitioner regarding the easily available sources and most reliable sources. We includedAge, Area of practice and Place of practice wise difference in pattern for selection of

information sources.

The study was carried out at three different places namely Manipal, Udupi and Manglore

by using sample size of 100. In the initial study we started with literature review then

followed by research methodology which includes source of information that is primary

and secondary sources, sample size and sampling technique. Then we set questionnaires

which contains 10 questions. The question was like, the type of practice, age of physician,

easily available sources preferred sources and the most reliable sources. For the collection

of data we used the convenient sampling technique, data which was obtained from the

study was analysed and interpreted by tables, graphs and charts. Based on interpretation

we derived conclusion and some recommendations.


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Literature review


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The general aim of this work was to study the use, by practising physicians, of drug

information at present available and their information needs for the future. By asking general

practitioners for their views, information was obtained from those who had first-hand

knowledge of the difficulties involved in updating their own information about drugs. The

study was also designed to see where particular sources of information had their main impact.

A total of 252 questionnaires (52%) was completed and returned. A chi-squared table was

constructed to test the representativeness of the respondents. Data which were available for

both respondents and non-respondents, such as age distribution, sex, education, number of

years qualified and number of partners, were used. There was no significant difference shown

at the 5% significance level using these criteria. Other parameters were not used.

The list of information sources, which can be subdivided in a number of ways, was divided

between 'industrial' and 'professional'. Nine sources emanating directly from the

pharmaceutical industry are referred to as industrial. All other sources except the media are

termed 'professional' (Prof), though it is not intended to suggest that information leaving the

industry is any less professional. The professional sources included colleagues, consultants,

medical journals (which are clearly medical) and also the Prescribers Journal and the British National Formulary (BNF).The media formed an additional category. There were nine

'industrial' sources, professional sources and the media sources were further subdivided into

'active' information and 'passive' information. This classification depended upon whether or

not the information had been actively sought by the prescriber. The consultant, if contacted

by the general practitioner must be considered 'active', but when action is taken from

information supplied by a consultant's letter, the consultant, as a source, becomes 'passive'.

This gives the 'active/passive' category for a consultant.

From the list of sources in the questionnaire, each doctor was asked to rate each source on a

five point scale from 'very good' to 'very poor'. The order of the various sources in this tablewas derived by multiplying each 'very good' rating by 5, each 'good' by 4, etc., to 1 for each

'very poor' with 0 for no response. A refinement was added in which the doctor was asked to

specify, in rank order, the five sources he found most useful in general. These results are

shown in Table 2 and indicate the more personal view of the practical usefulness of

information sources.

The general practitioner needs to treat patients. Information on a particular therapy may be

required while the patient is sitting in the surgery, and telephoning at this stage could be

embarrassing for both parties. A quick, concise source of drug information, providing a

certain amount of detail about contraindications, cost and incompatibilities on new and

established drugs, is required. The majority regard Mims as filling this requirement.

The other sources in the top five highlight the doctor's need for more detailed reliable

information on which to base a prescribing decision or from which to gain reassurance before

prescribing new drugs. Apart from the consultant, all sources in the top five are passive and

the consultant's information is often in the form of a letter which also is passive.

It is often assumed that drug adoption is a process (Coleman et al. 1966). The process

consists of cognitive stages through which a potential prescriber must pass. Two of these

stages are 'awareness' and 'evaluation. Awareness of a new product is generally considered


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to be a passive activity (Has singer 1959). In the case of new drugs, the pharmaceutical

industry is usually left to inform doctors of a new product's existence by means of the data

sheet followed by a visit from the drug firm representative and direct mail. However, some

new drugs are mentioned on radio or television before they are advertised to the prescriber.

For the evaluation of a new product, different sources of information are used. It might be

assumed that more 'professional' sources would be chosen at this stage. Evaluation is

orientated towards a more personal approach: 'How will the new drug help me in my

practice?' Rogers calls this stage a 'mental trial' (Rogers 1962). Two questions were asked in

the questionnaire to find which sources were used at which stage1. The results are shown in

Using the 'industrial'/'professional' classification, the first five sources chosen for 'awareness'

contain three 'industrial' sources which included the first two places. Where 'evaluation' was

needed the first five sources chosen were all 'professional'. This reliance on the industry to

supply information on new products is not- repeated when product evaluation is necessary,

which perhaps shows a healthy scepticism. Cross-tabulation of the sources of information

against divisions of the characteristics previously listed (variables) were constructed and

tested for significance using the chi-squared test or the proportion test (Strickland-Hodge

1979, appendix 3, p 283). Using this latter test, it was found that, for drug evaluation, single- practice doctors cited the representative significantly more often than did joint-practice

doctors. The use of sources of information at the 'awareness' and 'evaluation' stages were

cross tabulated with the 'medical age' of the general practitioners subdivided into three groups

according to the number of years qualified. The results are shown in Tables 5 and 6. There

are two aspects from which the major differences shown in Table 6 arise. Consultant

recommendations are used more at this stage by the older doctors; Drug and Therapeutics

Bulletin is used more by newly qualified doctors.

It is concluded that at the evaluation stage newly qualified doctors use Drug and Therapeutics

Bulletin significantly more than their older colleagues. Since 1976, Drug and TherapeuticsBulletin has been given to all final year medical students, doctors up to four years after

qualifying, trainee GPs and to new principals in general practice. Established general

practitioners would have received the journal only after subscribing. Newly qualified doctors

will therefore have had more opportunity to hear favourable reports of Drug and Therapeutics

Bulletin and are more likely to have used it than their older colleagues. It would be

interesting to see if the percentage citations given in the 0-5 years group are maintained as

the doctors progress through the '6-30 years' and eventually the '31 or more years' groups.

The consultant is used more by the '31 or more years' group than by either of the earlier

groups. These results are also in agreement with Wilson (1963). The general practitioner

refresh is patients to a consultant when specialist treatment or advice is required. The

reputation of the consultant in the eyes of the general practitioner will only increase over time

as more patients are seen. The newly qualified practitioner needs time to evaluate the worth

of a consultant's advice. By referring patients to a particular consultant, a personal

relationship can be developed which will increase the likelihood of contact when a problem

associated with new drug therapy is encountered.

The more qualified doctors, such as MRCGP, MRCP or FRCS, used Prescribers' Journal

more than the 'first degree only' doctors. Also, those doctors who were Members of the Royal


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College of General Practitioners used Drug and Therapeutics Bulletin significantly more than

their colleagues. This might be because this group would have contained more trainers (of

trainee GPs). Similar tests were used for each division of all the other variables under

consideration. It was found that industrial information (defined as all information emanating

from the pharmaceutical industry) was cited significantly more often by older, single-practice

doctors who had a first degree only, did none of their own dispensing and who did not

specialize. 'Industrial' information is used at the awareness stage of drug adoption almost to

the exclusion of the other forms, while 'professional' sources (defined basically as other

sources but excluding the media) were used to evaluate new drugs. However, certain

divisions of some of the variables did not fit this general rule.

The complete list of sources was considered for each subdivision of each variable. A chi

squared test was carried out giving the estimated values of each 'cell' and certain sources ofinformation were selected for further analysis. These further sources were each tested by the

proportion test. Within the variable 'partnership number', single-practice doctors rated directmail, the BNF, controlled circulation journals and the consultant to be significantly more

useful than did joint-practice doctors, which was again in agreement with Wilson

(1963).Newly qualified doctors rated Drug and Therapeutics Bulletin to be significantly moreuseful than did their older colleagues, whereas doctors who had been qualified longest rated

the representative, Mims, the consultant and textbooks more highly than did their newly

qualified colleagues. Doctors qualifying from a university local to their practice area rated the

Data Sheet Compendium and Prescribers' Journal to be significantly more useful than did

other doctors. This latter group rated colleagues and articles in medical journals to be

significantly more useful than did the 'local' doctors. Doctors who have 'higher qualifications'

rated articles in medical journals to be more useful than their colleagues. The 'first-degree

only' doctors rated all sources of information more favourably than did their more highly

qualified colleagues, perhaps implying less discernment by the former. Whether or not a

doctor is a 'dispensing doctor' did not appear to influence his or her choice, or rating of

sources of information. The 'specialists' (self-designated) rated the BNF and PrescribersJournal to be significantly more useful than did the non-specialists who rated the

representative and the consultant more highly.


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Objectives


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Primary objective

The primary objective of the study is to find out the perception of the medical

practitioner regarding source of information for new therapies.

Secondary objective

The secondary objectives of the study are as below:

To find age and place of practice wise difference in selection of information sources.

To find out the perception of doctors regarding Medical Representative, as a source of

information.

To find out the perception of doctors regarding preferences of source of information.

To find out the perception of doctors regarding easily availability of source of

information.

To find out the source which doctors believes most.


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Research Methodology


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Source of information

Data was collected from secondary and primary sources. Secondary sources were

journals, news papers and internet sources. Primary data was collected from medical

practitioners in Manipal, Udupi and Manglore by self administered questionnaires.

Primary source

Medical practitioners

Secondary sources

Journals, Magazines, newspaper articles and internet sources

Method of data collection

Place of data collection

The data for pilot study was collected from various places in Manipal and data for

major study was collected from various medical practitioners working as private

practitioners, working in medical college and private hospitals in various places of

Manipal, Udupi and Mangalore.

Sampling technique

We have selected Non Probability Convenience technique and quota sampling for the

collection of data. We directly approached medical each medical practitioners and

asked to fill the questionnaire according to their perception.

Sample size

For major study, we selected 100 medical practitioners and divided them between

general practitioners and specialists.

Questionnaire

Structured questionnaire containing both open ended and close ended questions were

prepared for medical practitioner.

Pilot study

Pilot study was done by collecting the data from 10 medical practitioners in Manipal

before starting major survey.

Data analysis and Data Interpretation

The data collected from major study has been analysed and interpreted in the form of

tables, line charts and pie charts.


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Data presentation, Analysis and Interpretation


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Q.1 Type of practice of the medical practice.

Tot l l i i

Table: 1 Type of medical practitioners

Serial no. Type of practice No. of doctors

1 General practitioners 31

2 Medicine 10

3 Surgeons 8

4 Paediatrics 15

5 Cardiologists 7

6 Oncologists 8

7 Gynaecologists 6

8 Dermatologists 5

9 Ophthalmologists 5

10 Eye, Neck and Tongue 5

11 Psychiatrists 212 Urologists 2

Total 100

We have selected 100 medical practitioners and divided them bet een general

practitioners and specialists. Out of whom 31 are general practitioners and 69 are

specialists from various specialities as showed in the above table.

Chart: 1 Type of practitioners

31

69

Type of practitioners

General practitioners

Specialists

Total sample

si e= 100


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Chart: 2 Type of practitioners

0

5

10

15

20

25

30

35

40General practitioners

Medicine

Surgeons

Paediatrics

Cardiologists

Oncologists

Gynaecologists

Dermatologists

Ophthalmologists

Eye, Neck and Tongue

Psychiatrists

Urolosists

Total samplesize= 100


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Q.2 Age of medical practitioners

Objecti e

We divided medical practitioners in different age range as shown below. The primary

objective ofadding this question is toidentify whether any age wise difference in selection

ofthe s

ource

ofin

formati

on regarding new therapies

or n

ot.

Table: 2 Age of medical practitioners

Serial No. Age group No. of doctors

1 25-35 50

2 35-50 34

3 Above 50 16

Chart: 3 Age group of medical practitioners

Q-3 Area of practice of medical practitioners.

Objecti e

Medical practitioners were asked to mention the area of practice i.e. whether they are

practicing in rural or urban area. The intention to ask this question was to identify the

differences in selection of information sources according to their area of practice.

However we had collected data only from urban area.

50

34

16

Age group of medical practitioners

25-35 35-50 Above 50


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Q-4 Are you working as pri ate practitioner or in medical college or in

pri ate hospital?

Objecti e

The main objective behind asking this question to the medical practitioner is to know

whether any place of practice wise difference in selection of the source of informationregarding new therapies or not.

Table: 3 Place of practice

Serial No. Place of practice No. of doctors

1 Private practitioners 20

2 Medical college 70

3 Private hospital 10

Chart: 4 Place of practice

Chart: 5 Pri ate Practitioners

20

70

10

Place of practice

Private practitioners Medical college Pr ivate hospital

Total sample si e=100

8479

74 7468

5853

47

32

16 1611 11

5 5

01020

304050

60708090

100

Pri ate Practitioners


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Chart: 6 Practitioners working in Medical College

Chart: 7 Practitioners working in private hospitals

Result

As shown in the charts: 5, 6 and 7

The medical practitioners working as private practitioner mainly prefer CMEs

followed by medical journals, MIMS, professional contacts and textbooks.

The medical practitioners working in medical college mainly prefermedical journals

followed by, textbooks,CMEs and MIMS.

The medical practitioners working in private hospitals mainly prefermedical journals,

and internet followed bytextbooks, MIMS, CMEs and professional contacts

87 83 8276

46 44

3427 25 23

11 10 10 70

01020304050

60708090

100

Practitioners working in Medical college

89 89

7867 67 67

44

33 33

22 22

11 11

0 0

0102030405060708090

100

Practitioners working in rivate os itals


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Q-5 Do medical representati es visit regularly?

Objective

We asked this question to each of medical practitioners in order to know whether

medical representatives visit regularly or not. It was Yes/No type question and they

answered as sho

wn belo

w.

Table: 4 Regularity of medical representatives

Serial No. Answer No. of doctors

1 Yes 93

2 No 7

Chart: 8 Regularity of medical representatives

Result

As shown in above table: 4 and chart: 8

Outof100 medical practitioners93 said yes, medical representatives visit regularly.Outof100 medical practitioners7said No medical representatives do not visit regularly.

93

7

Regularity of medical representatives

Yes No

Total sample

si e= 100


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Q-6 Do you rely on the information provided by medical representatives

regarding new therapies?

Objective

The main objective behind asking this question to the medical practitioners was to know

whether they rely on information given by medical representatives regarding newtherapies or not.

Table: 5 whether rely on information given by MRs or not?

Serial No. Opinion No. of practitioners

1 Yes 37

2 No 63

Chart: 9 whether rely on information given by MRs or not?

Result

As shown in above table: 5 and chart: 9

Outof100 medical practitioners 37 said yes, they rely on the information give by Medical

Representatives.

Outof100 medical practitioners 63 said No, they do not rely on the information given by

MedicalRepresentatives.

37

63

Yes

No

Total sample

si e= 100


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Q-7 If Yes/No then why Please give your opinion.

Objective

Based on the question No. 6, we asked medical practitioners to give their opinion about

why they rely or do not rely on the information given by medical representatives. All of

them responded in different manner and gave vary opinions. Some of them even did notgive their opinions. We categorised their opinions based on whether they said Yes or No

in Q-6.

The main objective behind asking this question to the medical practitioners was to identify

their perception towards medical representatives as sources of information regarding the

new therapies.

Few common reasons given by practitioners who said that Yes they rely on information

given by medical representatives:

1. Do not completely rely on medical representatives or rely after evaluation of

information by other sources.

2.

They support their information by ample research and valuable data.

3. They are representatives of company who has actually done drug trials.

4. Detailed information given by them only.

5. They give latest information about new therapies and drug.

6. Information given by them is authentic.

7. Rely only on who are regular, tested and tried.

Few common reasons given by practitioners who said that No they do not rely on

information given by medical representatives:

1.

They are biased towards their product and company.

2. They are only for promotion of their products.

3. Show fake clinical data.

4. Information given by them is incomplete. Sometimes they do not know much about

drug or disease.

5. Other sources like medical journals, text books, CMEs are more reliable than Medical

Representatives.


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Q-8 which other sources of information do you prefer

Objective

This question was asked to the medical practitioners in order to identify that which other

sources of information (other than medical representative) they prefer. However this was

asked to know that how many information sources are used and how frequently they areused.

Chart: 10 Preference of information sources other than medical representatives

Result

As shown in above chart, it was found that medical journal is the highest preferred

sources of information with score of85 out of 100, followed by textbooks, internetsources and CMEs with almost similar scores of 79, 78 and 76 respectively.

Other sources like MIMS, professional contacts, drug symposia and consultant

recommendations and prescribers journals stood at intermediate position with

scores of 52, 51, 35, 30 and 28 respectively.

Rest of sources like drug information unit (hospital), direct mail CCJs, advertisements

and drug firm exhibition showed leas preference as shown in above chart.

85

79 7876

52 51

35

3028

19

1410 10

8

1

0

10

20

30

40

50

60

70

80

90

100



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Q- which sources of information is easily available

Objective

The objective of asking this question was to know the perception of medical practitioners

about easy availability of sources. We asked to mention three sources those are easily

available to them in priority. They responded vary among three options as shown below.

Table: 6 Ease of availability of sources

Serial No. Source of

information

No. of practitioners

1st

priority 2nd

priority 3rd

priority

1 Internet 40 16 16

2 Medical journals 16 21 16

3 CMEs 14 16 10

4 Text books 13 31 115 MIMs 8 5 10

6 Medical

representatives

7 3 4

7 Professional contacts 2 3 8

Chart: 11 Ease of availability of information source (1st

priority)

40

1614 13

8 7

2

0

5

10

15

20

25

30

35

40

Internet

Medical journals

CMEs

Text books

MIMs

MedicalrepresentativesProfessional contacts

Ease of availability of information source(1 st priority)



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Chart: 12 Ease of availability of information source (2nd

priority)

Chart: 13 Ease of availability of information source (3rd priority)

Result

Based on above data for the easy availability of information sources, we interpreted the result

as below.

In the 1st

priority, internet was rated the highest with score 0f 40/100 followed by

medical journals with score of 16/100 and CMEs 14/100.

In the 2nd

priority, textbook was rated the highest with score 0f31/100 followed by

medical journals with score of 16/100 and CMEs and internet 14/100.

In the 3rd

priority, medical journals and internet were rated the highest with score 0f

16/100 followed by textbookwith score of 11/100.

16

21

16

31

53 3

0

5

10

15

20

2530

35

40

Internet

edical

ournals

s

Text books

I

s

edicalrepresentatives

Ease of availability of information source(2 nd priority)


16 16

10 11 10

48

0

510

15

20

25

30

35

40

Internet

edical

ournals

s

Text books

I

s

edical representatives

Professional contacts

Ease of availability of information source(1st priority)



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Q- 10 Prioritise any three information sources those you rely on most

Objective

The primary objective behind asking this question was to know the perception of medical

practitioners about their priority in selection of information sources. We asked to mention

three sources those on they rely. They responded vary among three options as shownbelow.

Table: 7 Priority sources

Serial No. Source of information No. of practitioners

1st

priority

2nd

priority 3rd

priority

1 Medical journals 26 31 13

2 Text books 24 15 17

3 Professional contacts 16 8 11

4 CMEs 14 20 14

5 Internet 12 5 16

6 MIMs 3 7 6

7 Consultant recommendation 2 4 5

8 Medical representatives 1 4 4

9 Drug symposia 1 5 3

Chart: 14 Priority sources (1st priority)

2624

1614

12

3 2 1 1

0

5

10

15

20

25

30

35

Medical journals

Text books


CMEs

Internet

MIMs

ConsultantrecommendationMedical representatives

Pririty sources (1st priority)



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Chart: 15 Priority sources (2nd

priority)

Chart: 16 Priority sources (3rd

priority)

Result

Based on above data for the easy availability of information sources, we interpreted the resultas below.

In the 1st

priority, medical journals was rated the highest with score 0f26 out of 100

followed by textbookand professional contacts with score of 24 and16 respectively.

In the 2nd

priority, medical journals was rated the highest with score 0f31out of 100

followed by CMEs and textbookwith score of 20 and 15..

In the 3rd

priority, textbook, internet, CMEs and medical journals were rated almost

similar with score 0f17, 16, 14 and 13respectively.

31

15

8

20

57

4 4 5

0

5

10

15

20

25

30

35

edical

ournals

Text books

rofessional contactsC

Es

Internet

I

s

Consultant recommendation

edical representatives

Drug symposia

Pririty sources (2nd priority)

Total sample

size=100

1317

1114

16

6 5 43

05

10

15

20

25

30

35

edical

ournals

Text books


C

Es

Internet

I

s

Pririty sources (3 rd priority)



27/32

Conclusion


28/32

After comprehensive analysis and interpretation of the data collected from medical

practitioners from various places of Manipal, Udupi and Mangalore and we have derived

wonderful conclusion.

Place of practice

Based on data analysis we found difference in pattern of selection of information sources

as per the place of practice e.g.

Private practitionerspreferCMEs and medical journals.

The medical practitioners working inmedical college mainly prefermedical journals

and textbooks.

The medical practitioners working in private hospitals mainly prefermedical

journals and internet.

Medical representative as Source of information

We have collected data from 100 medical practitioners and asked about their perception

towards information provided by medical representatives. There is vast difference inpattern of selection of information sources. Out of 100 medical practitioners 93 said that

medical representative visit regularly. Out of 100 medical practitioners 63 said that they

do not rely on the information given by medical representatives by giving reasons that

they are biased or provide fake data etc. However 37 practitioners said yes, they rely on

medical representatives by giving reasons that they provide latest information based on

clinical research.

Perception towards sources of information other than medical representatives

Amongst various sources of information medical journals is preferred highest followed

by textbooks, internet and CMEs. Other sources like MIMS, professional contacts, drug

symposia, consultant recommendations and prescribers journals stood at intermediate

position. The least preferred sources are drug information unit (hospital), direct mail

CCJs, advertisements and drug firm exhibition.

Ease of availability of information sources

In the 1st

priority, internet was preferred highest followed by medical journals and

CMEs. In the 2nd

priority, textbookwas preferred highest followed by medical journals,

CMEs and internet. In the 3rd

priority, medical journals and internet were preferred

the highest followed by textbook.

Most preferred sources

In the 1st

priority, medical journals was preferred highest followed by textbook and

professional contacts.

In the 2nd

priority, medical journals was preferred the highest followed by CMEsand

textbook.

In the 3rd

priority, textbook, internet, CMEs and medical journals were rated almost

similar.


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Recommendations


30/32

After studying the result we found some suggestions for pharmaceutical companies,

medical representatives and medical practitioners.

1. During the study we found that the most of medical practitioner they dont rely on the

information given by medical representative because they believe that medical

representatives do not much about product. So medical representative should be from

medical back ground with qualifications like B. Pharm and D. Pharm.

2. Considering the busy time schedule and convenience of physician, E-detailing should

be included as a part of scientific education and promotional activity and however

accessibility of physician to computer and internet should be considered.

3. Company should change their reputation from only promotion oriented to provide

detailed scientific information about their product to the medical practitioners by

medical representatives, CMEs and symposia.

4.

Medical practitioners should change their attitude towards and ask for moreinformation to the company medical department.


31/32

Bibliography


32/32

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