1. Prescription of New Drugs by General Practitioners in Pakistan: An Exploration into Information Sources, Prescription Influences and General Attitudes Dileep K. Rohra, Ali Jawaid, Tauseef-ur-Rehman, Abdul Q. Sukkurwala, Alfiya S. Palanpurwala*, Rajesh Gangwan *Department of Biological and Biomedical Sciences, Aga Khan University
Introduction
Commercial launch of a new drug always brings along a hope of greater efficacy and better tolerance. In Pakistan, where an average of 2000 brands are approved for marketing by Drug Control Division, Ministry of Health, Government of Pakistan annually, there is a dearth of studies on the topic of sources of information used by physicians regarding new drugs and important factors which lead to actual prescription of these drugs.
Results
A total of 124 accurately and adequately filled Questionnaires were used in the analysis. The sample included a higher proportion of males with the male to female ratio being 74:26. Respondents were divided into three categories based on their academic qualification: 60.0% of the participants had no PG training, 18.4% had some PG training (e.g. doctors holding the MCPS and DCH degree), and 13.6% were specialists with an FCPS in family medicine. 8% did not mention their academic qualification.
Table 1. Basic characteristics of the GPs who were a part of this study
Males
n = 92 (74%)
Females
n = 32 (26%)
Years since last degree
n = 108, 17 missing; Mean = years ± 9.63,
Range = 0-44
Patients seen monthly
n = 95, 30 missing; Mean = 504 ± 384,
Range =
Figure 1. Sources of information for new drugs as percentage of the respondents 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Medical Journal Articles
Medical Books
Newspapers
Drug bulletins
National formulary
Pharma Guide
Colleagues
Consultants
Pharma representatives
Sponsored Meeting
Direct Mail
Journal Advertisements
Hospital Doctors
Internet
Figure 2. Factors which influence doctors when they start prescribing new drugs as percentage of cases
Other Incentive by Pharma Industry
Endorsed in meeting/conference
Convenience and Acceptability
Good Reputation of Company
Any other colleague related
Side-Effects of Current Drugs 0%
10%
20%
30%
40%
50%
60%
70%
80%
Pharma Representatives
Advertisements
Drug Samples
Colleague Endorsement
Patient request for drug
Press
Medical Journals
Cost
Novel Drug
Curiosity
Internet
Other
AIM OF STUDY
The aims of this study were to explore the common sources of information concerning new drugs for the General Practitioners (GPs) and to study different factors influencing their prescription.
METHODS
The study design selected was cross-sectional descriptive. Licensed GPs registered to Pakistan Medical and Dental council working in both institutional and independent settings were made the target population. 124 GPs from 5 districts of Pakistan namely Karachi, Lahore, Hyderabad, Multan, Larkana and other smaller towns participated in the study. They were interviewed with the help of a Questionnaire. Potential sources of information and influential factors regarding prescription derived from a thorough review of literature were listed in the Questionnaire.
When asked what the most important advantage of a newly launched drug should be, 60% considered it be less cost as compared to previous drugs. 32% thought of decreased side effects and 30% of convenience to the patient as being the most important benefit. 14% gave other reasons as well which included increased availability, change of brand name for the patient and good packaging.
The behavior of the doctors when giving a newly launched drug to minors and pregnant was also evaluated. 45% would avoid giving a newly launched drug to pregnant females and 32% would do so in the case of minors. Rest would prescribe the drug after looking at the literature for any specific contra-indications in these two special groups.
CONCLUSION
The results of our study establish pharmaceutical representatives and pharmaceutical advertisements as the major source of information regarding new drugs for GPs in Pakistan followed by Pharma guides, medical colleagues and medical journals.