What happens when private general practitioners receive incentivisation offers from pharmaceutical sales representatives? A qualitative study in Pakistan.

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES Journal of Health Services Research & Policy Pub Date : 2024-07-01 Epub Date: 2024-02-01 DOI:10.1177/13558196241230853
Muhammad Naveed Noor, Afifah Rahman-Shepherd, Sabeen Sharif Khan, Rumina Hasan, Amna Rehana Siddiqui, Iqbal Azam, Faiza Bhutto, Afshan Khurshid Isani, Sameen Siddiqi, Robyna Irshad Khan, Sadia Shakoor, Mishal Khan
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Abstract

Objectives: Pharmaceutical incentivisation of physicians for profit maximisation is a well-documented health system challenge. This study examined general practitioners' (GPs) reactions to pharmaceutical incentivisation offers in one region in Pakistan.

Methods: We used the Standardised Pharmaceutical Sales Representative (SPSR) method and qualitative interviews with GPs. SPSRs were field researchers representing mock pharmaceutical companies who recorded their observations of 267 GPs' responses to pharmaceutical incentivisation offers. We triangulated SPSR data using qualitative interviews with a subset of the same GPs to gather information about how they interpreted different interaction outcomes.

Results: We found four major outcomes for GPs being offered incentives by pharmaceutical companies for prescribing medications. GPs might agree to make incentivisation deals, reject incentivisation offers, disallow PSRs to access them, or remain indeterminate with no clear indication of acceptance or rejection of incentivisation offers. GPs rejecting SPSRs' incentivisation offers indicated having active commitments to other pharmaceutical companies, not being able to work with unheard-of companies, and asking SPSRs to return later.

Conclusions: The GP-pharmaceutical sales representative interaction that centres on profit-maximisation is complex as offers to engage in prescribing for mutual financial benefit are not taken up immediately. The SPSR method helps understand the extent of distortion of practices impacted by incentivisation. Such an understanding can support the development of strategies to control unethical behaviours.

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当私人全科医生收到药品销售代表的奖励时会发生什么?巴基斯坦的一项定性研究。
目标:为实现利润最大化而对医生进行药品激励是一项有据可查的医疗系统挑战。本研究考察了巴基斯坦一个地区的全科医生(GPs)对药品激励提议的反应:我们采用了标准化药品销售代表 (SPSR) 方法,并对全科医生进行了定性访谈。SPSR 是代表模拟制药公司的实地研究人员,他们记录了对 267 名全科医生对药品激励方案反应的观察结果。我们利用对同一全科医生子集的定性访谈对 SPSR 数据进行了三角测量,以收集有关他们如何解释不同互动结果的信息:结果:我们发现,全科医生在接受制药公司提供的处方奖励时会产生四种主要结果。全科医生可能会同意进行激励交易,也可能会拒绝激励提议,不允许私人医生代表获得激励,或者保持不定,没有明确表示接受或拒绝激励提议。拒绝SPSR激励提议的全科医生表示已与其他制药公司达成了积极的承诺,无法与闻所未闻的公司合作,并要求SPSR稍后返回:全科医生与药品销售代表之间以利润最大化为中心的互动是复杂的,因为双方都不会立即接受为了经济利益而参与处方的提议。SPSR 方法有助于了解受激励机制影响的实践扭曲程度。这种认识有助于制定控制不道德行为的策略。
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来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
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