Perception of physicians towards pharmaceutical promotion in India

Abstract

Pharmaceutical firms spend a significant amount of their budget on promotions. Thus, it becomes imperative to study the perception of physicians, at whom a major share of these promotional efforts is targeted. Despite this, there exists very little published research examining customer response at the perceptual level. Thus, the authors have attempted to study the importance attached to promotion tools as information sources and the extent to which these promotion tools influence prescription behavior as perceived by physicians. Primary data for the study was collected through a survey of physicians. A total of 115 physicians participated in the study. The study indicates that physicians perceive conferences/symposia to be the most credible information source. An examination of the relationship between perceptions regarding various promotion tools and demographic variables indicates a significant relationship between gender and type of hospital and credibility attached to the various promotional tools. The study indicates a positive correlation between credibility of promotion tools and the extent to which it influences prescription behavior.

Keywords

Perceptions physician promotion tools prescription behavior India

Introduction

Pharmaceutical promotion tools educate, inform and update the physicians regarding the prescription drugs available. It is the uniqueness of the pharmaceutical market that a major proportion of pharmaceutical promotional tools are directed towards the physicians who enjoy the veto power in making the decisions related to purchase and non-purchase of the product. The physician is the prime influencer and decision maker in the choice of drug for the customer i.e, patient. In fact, he is the only non-purchaser who takes complete authority over decision making for the consumer. The physicians’ prescription behavior is influenced by multiple factors including promotion by pharmaceutical companies. Pharmaceutical marketers invest considerable amounts in promotional efforts targeted at physicians. The current research attempts to study the perception of physicians in India regarding promotion tools directed at them by pharmaceutical marketers and the influence that these have on their prescription behavior. With spending on promotion the fastest growing component of the marketing budget for prescription drugs, concerns about quality and promotional effectiveness have grown over the past few years in the pharmaceutical industry.¹ Despite this fact, little detailed material is available regarding the methodological aspects of predicting the effects of promotion.² Thus, it becomes imperative for the marketers to study the perception of physicians towards the promotion tools being used by the pharmaceutical companies.

Literature review

Successful marketing by pharmaceutical manufacturing companies to members of the medical profession is greatly determined by a good understanding of the various factors that influence their purchasing behavior. More specifically, it would be of benefit to pharmaceutical marketers to ascertain to what extent prescribing decisions are influenced by company’s own promotional tools.³

Perceptions of physicians towards promotion done by drug companies

Drug promotion done by pharmaceutical companies does have an influence on physician’s prescription behavior. Akande and Aderibigbe⁴ found that drug promotion material served as an incentive to physicians to prescribe promoted drugs in preference to their alternatives. Physicians also get guided by the research about the drugs apart from the promotion done by the pharmaceutical companies. Hemminki⁵ reports that the major influences on prescribing are research and the pressures from drug firms, and proposes a simplified model to describe the decision-making process for prescribing drugs. If research and journal could guide the prescription trends, then it would have been impossible to get uniformity in drug prescription. Pressure from drug firms influences physicians’ prescription behaviour through education, scientific journals and advertising according to the doctor’s personal characteristics, his work and his therapeutic opportunities. A better explanation to this can be attributed to pharmaceutical promotion. Pharmaceutical companies provide evidence and disseminate information pertaining to drug usage and thus lead to uniformity in drug usage. Pharmaceutical companies influence the physicians’ prescription by promoting the drugs to them by medical representative, educational programs (like sponsored conferences and seminar), advertisement, free samples and gifts. Physicians’ also get influenced by non-promotional drug information sources like journals, drug house periodical, reports of clinical studies, company websites, medical association, chemist and patients. The current study is guided by the following model.

Figure 1.

Influencers of physician prescription behaviour.

Promotional tools used by pharmaceutical industry

Marketing’s role in this process of developing a pharmaceutical should lie in finding relevant product position and building brand identity compliant with real product capabilities.⁶ Industrial marketing studies highlight the relative significance of advertising for marketers (Thompson, 1966).⁷ Studies conducted in the field of pharmaceutical marketing have also highlighted the importance of personal selling. Another study conducted by Taneja and Arora^8,9 was based on analysis of different promotional tools used by pharmaceutical industry viz., physicians samples, medical equipments as gift, greeting on birthdays and anniversaries with cake’s and gifts, regular visits of medical representative or manager, subscription of journals, sponsorship for personal tours, textbook as gift, participation by company in CMEs/conferences, promotion through internet/websites/SMS, sponsorship for stay in conferences, organization of free disease detection camps, high value personal gifts, sponsorship for travel expenses in conferences, product literature and updates, personality of medical representative and manger, low value gifts.

A regular visit by a smart medical representative is found to be the best tool of promotion for a pharmaceutical company. Text refers to medical representative as a missionary sales man. The missionary sales person is not expected or permitted to take an order but is called on only to build goodwill or to educate the actual or potential user.¹⁰ According to Campo et al.,¹¹ detailing came out to be most powerful pharmaceutical marketing instrument in the process. Creyer and Hrisistodoulakis¹² conducted a survey of 235 residents at a large, Midwest teaching hospital to understand how marketing activities influence physician’s impressions of the pharmaceutical industry. It was found that physician form more positive impression of pharmaceutical sales representative when the reps provide accurate information, are trustworthy and behave ethically. When physicians form more positive impressions of pharmaceutical sales reps, they tend to believe that pharmaceutical industry understands their needs as well. And when physicians feel that pharmaceutical industry understands their needs, they hold a more positive attitude towards the pharmaceutical industry overall. Brand and Kumar¹³ mentioned that medical representative form the best medium for building trusted and valued relationships with targeted physicians.

Not simply medical representative but also prescription drug samples have been reported to be influencing physician prescription behavior. Free drug samples serve as a marketing tool.¹⁴ According to Groves et al.,¹⁵ drug samples are of current interest because of their influence on prescription and potential impact on patient safety. Also, the researchers have deliberated that very little research has been conducted into the use and misuse of prescription drug samples.¹⁶ However, studies have established that free drug samples have positive and statistically significant effect on number of new prescriptions issued by a physician.¹⁷

Maintaining contact with patients is especially relevant for products intrinsically linked to customer’s concerns.¹⁸ Direct to Consumer Advertising (DTCA) has been found to be influencing consumers for the duration for which the therapy was taken. Although not much data could be found on drug advertisements in medical journals, during pilot survey it was found that advertising in medical journals acts as a good source of information.¹⁹ Campo et al.¹¹ did a qualitative analysis of the physicians' decision process for drug prescription. It was found during the study that free conference participation influences drug choice in some situations.

In India, drug promotion tools used by pharmaceutical companies can be broadly represented as medical representatives, samples, advertisements (in journals, DTCA, mailers), conducting conferences, symposium and scientific meetings and gifts (scholarly and non-scholarly). Lal²⁰ has comprehensively enlisted the promotional activities by pharmaceutical industry in India, which include the activities of medical representatives, drug advertisements to physicians, provision of gifts and samples, drug package inserts, direct-to-consumer advertisements, periodicals, telemarketing, holding of conferences, symposium and scientific meetings, sponsoring of medical education and conduct of promotional trials.

Prescription drug information source

Physician use of particular types of prescription drug information source has received considerable attention in literature. Numerous studies have focused on physician use of pharmaceutical firm prescription drug information, e.g., journal advertising, sales representatives and direct mail literature.²¹ Attention has also been given in a general sense to the effects of intra-firm and inter-firm communications on purchasing decisions.²² In the specific area of pharmaceutical marketing consideration was given to the influence of advertising in medical journals,²³ and also to a comparison of medical journal and direct mail advertising.²⁴ These studies, however, appear to overlook the relative importance of the various influencing factors, as suggested by Parasuraman.²⁵ Evans and Beltramini²⁶ investigated the perceived usefulness of drug information sources by conducting a physician survey. On applying statistical tools, it was found that physicians’ perceptions differ amongst various groups like general practitioners (GPs)/ specialists and younger/ older physicians. It was found that physician subgroups differ in the importance they attach to drug information sources. It was also stated in the study that physicians seek drug information from journal articles, followed by colleagues and conventions.

There is evidence of different classification terminology adopted by various authors. Vancelik et al.²⁷ has named the organizational sources discussed above as the commercial sources of information. It was found that commercial sources of information have greater influence than scientific sources on GPs prescribing behavior in underdeveloped and developing countries. Their study was aimed at studying the self-reported impact of pharmaceutical promotion on the decision-making process of prescription of GPs in Eastern Turkey. Study was conducted on 152 GPs. It was reported that the commercial information provided by medical representatives was highly influential on their decision-making process of prescription.

Evans and Beltramini²⁶ reported that physicians were likely to solicit information from conferences and conventions. Trade meetings are ranked among the three top information sources among physicians for product information.²⁸ Manufacturer sponsored (for which the company bears the promotional expenses) sources of information like advertising and sales representatives, have received the most attention in the physician prescribing literature.^29,30 Though in general physicians have been found to place relatively limited importance on journal and direct mail advertising. Research results also indicate that physician awareness and recall of journal advertising and direct mail correlate with their prescribing of particular drugs.³⁰ Several studies have indicated that physicians view details of people as poor sources of information, generally disapprove of those physicians who use detail people.^31–33 However, contradictory findings have indicated that physician drug preferences do correlate with their preference for detail people, particularly in low-risk prescription situations. In fact, one early study found detail people to be the information source most frequently utilized by physicians at that time.³⁴ Social interaction or “peer effect” may also act as an information source because non-specialist physicians may rely on prominent physicians.³⁵ However, there has been little empirical evidence that these opinion leaders matter. One of the study conducted found no peer effects at all on prescription behavior.^36,37 There are little or no chances for opinion leaders to act as an information source.

Pharmaceutical industry in India

When the allopathic system of medicine made its entry into the country is not available, but it is generally believed that it happened sometime during the early part of the 19th century. The medicines were imported by the British for their personal use when they came to do business. This was the beginning of Pharmaceutical Industry in India.³⁸

The Indian pharmaceutical industry, now a $19 billion industry (2009), has shown tremendous progress in terms of infrastructure development, technology base creation and the range of products (http://pharmaceuticals.gov.in/³⁹) and, of good quality pharmaceuticals of mass consumption.. The Department of Pharmaceuticals has been set up by the Government of India⁴⁰ in 2008 to facilitate the Indian Pharmaceutical Industry to ensure abundant availability, at reasonable prices within the country, and to enable the Indian pharmaceuticals industry to play a leading role in the global market. The Department is entrusted with the responsibility of policy, planning, development and regulation of Pharmaceuticals Industries. The following attributes constitute the basis of the technological strengths of the Indian Pharmaceutical Industry: (1) Self-reliance displayed by the production of 70% of bulk drugs and almost the entire requirement of formulations within the country; (2) Low cost of production; (3) Low R&D costs; (4) Innovative Scientific manpower; (5) Excellent and world-class national laboratories specializing in process development and development of cost-effective technologies; (6) Increasing balance of trade in Pharmasector; (7) An efficient and cost-effective source for procuring generic drugs especially the drugs going off patent in the next few years; (8) An excellent centre for clinical trials in view of the diversity in population (http://pharmaceuticals.gov.in/³⁹)..

The Indian pharmaceutical Industry has witnessed a robust growth of around 14% since the beginning of the 11th Plan in 2007 from about Rs. 71,000 crores to over Rs. 1 lac crores in 2009–2010 comprising some Rs. 62,055 crores of domestic market and exports of over Rs. 42,154 crores. This also amounts to around 20% of total volume of global generics. However, the industry is quite fragmented and comprises nearly 10,500 units with majority of them in unorganized sector. Of these, about 300‐400 units are categorized as belonging to medium to large organized sector with the top 10 manufacturers accounting for 36.5% of the market share. As regards the Bulk drugs component of the industry, the market is around Rs. 42,000 crores giving it a share of around 50% of the total domestic market. This gives the Indian Bulk Drug industry a share of about 9% of the global bulk drug market (http://planningcommission.nic.in⁴¹).

According to Bhangale (2008),⁴² pharmaceutical companies in India use medical representative, advertising, journals and mailers, patient and retailer communication as a part of their marketing strategy. Medical representatives are used for marketing products to physicians and to exert some influence over others in the hierarchy of decision makers. Typically, sales force expense comprises an estimated 15–20% of annual product revenues, the largest item on the balance sheet. Pharmaceutical companies are realizing that the brands used for common ailments like the common cold and coughs are increasingly being purchased over the counter (OTC). Thus, there is a tremendous potential to build these brands into “mega brands” just by promoting them directly to consumers, and some pharmaceutical companies are already working in this direction. Focusing on rural India is not a strategy known to be very popular with pharmaceutical companies, though commonly used by smaller ones. Normally, companies rely on key opinion leaders in metros, but some start in rural and semi-rural markets. Foreign multinational companies in India are launching branded generics – off patent drugs not discovered or developed by the parent – to widen their reach in Indian pharmaceutical market.⁴³

Study purpose

The study examines the credibility attached by physicians to promotional tools as information sources. Further, the extent to which these promotion tools influence prescription behavior as perceived by physicians has also been studied. Accordingly a set of hypotheses were formulated for examination in the study.

The authors have attempted to study whether different information sources have been attached differential importance, so that it helps practitioners to understand the specific sources to focus on:

H1a: There exists no significant difference between credibility ratings given by physicians for various information sources.

Authors have also tried to understand if this credibility is dependent on any specific demographic variable under study like gender and hospital kind. Authors also attempted to find out whether physicians’ demographics influence prescription or not. And thus the following hypothesis was formulated:

H1b: There exists no significant difference in the extent to which various promotional tools influence prescription on the basis of physician demographics.

Research methodology

Data collection instrument

Following the literature review and interviews with experts in the field, a structured questionnaire was developed for collecting primary data to meet the objectives of the study. The first part of the questionnaire was designed to obtain demographic information about doctor’s age, gender, educational qualification, specialty, kind of hospital physician is practicing in, prescription size. The second part comprised the items aimed at measuring the credibility the physicians attach to each of the promotional tool and the influence it has on their prescription behavior.

The survey of physicians was conducted in Delhi and Ghaziabad. The physician population was divided into two groups of private and government hospital. A total of 500 physicians were approached either personally or via e-mail. Usable questionnaires received were 115 with a response rate of 20%. Table 1 presents a summary of the demographic details of the respondents.

Table 1.

Demographic profile of respondents

Specialty (%)		Qualification (%)		Kind of hospital (%)
Dentistry	16.5	MBBS	38.3	Non-teaching government hospital	5.2
Orthopaedics	.9	MD	25.2	Non-teaching private hospital	22.6
Internal medicine	16.5	MS	13.9	Government Teaching Hospital	47.8
Psychiatry	20.0	DM	4.3	Private Teaching Hospital	20.0
Neuro-Psychiatry	1.7	MDS	14.8	None	4.3
Paediatrician	.9	BDS	.9	Total	100.0
Gynaecologist	5.2	Others	2.6	Age (%)
General Physician	19.1	Total	100.0	<35	69.6
Surgery	2.6	No. of prescription (%)		36-45	20.0
Cardiologist	1.7	1-20	18.3	46-55	9.6
Plastic surgery	1.7	21-50	31.3	>55	.9
Dermatology	.9	51-100	23.5	Total	100.0
Critical care	2.6	>100	25.2	Years of practice (%)
Neurologist	2.6	12.00	1.7	0-5	51.3
Chest Physician	3.5	Total	100.0	6-10	30.4
Nephrology	2.6	Gender (%)		11-15	12.2
Cardiologist	.9	Male	60.9	6-20	2.6
Total	100.0	Female	39.1	>20	3.5
Total	100.0	Total	100.0

Results and discussion

The scale used to measure the credibility of information sources in the study has a reliability score of 0.695. The scale used to measure physician’s perception of effect of promotion on prescription behavior has a reliability score of 0.715.

Relative credibility attached to information sources

Table 2 delineates the information sources considered in the study, and also the mean credibility scores for each, based on the ratings received from all the respondent physicians. The information sources are presented in descending order, according to their extent of credibility physicians attach to different information sources. Further, t-tests were performed to determine whether the mean importance for each factor was significantly greater than the one succeeding it. It is obvious from Table 2 that the results were statistically significant for conference/ symposia and journal; clinical studies and medical association; medical association and medical representative; medical representative and company website; advertisement and chemist, sample catch cover and advertisement, thus former is enjoying more credibility than the latter. It is not possible to say with any statistical certainty that among journal and clinical studies, company website and direct mail, medical representative and advertisement, the former is more credible as an information source than latter.

Table 2.

Descriptive statistics

Information sources	Mean credibility score(a)	Standard deviation
Conference/symposia	3.8 (b)	0.8
Journal	3.6 (c)	1.0
Clinical studies	3.4 (b)	0.9
Medical association	2.9 (b)	1.0
Medical representative	2.7 (b)	1.0
Co. website	2.6 (c)	1.0
Direct mail	2.5 (c)	1.1
Sample catch cover	2.4 (b)	1.1
Advertisement	2.1 (c)	1.0
Chemist	2	0.9

(

a) Mean credibility score is the average score on a 5-point scale, where 1 = very low credibility; 2 = low credibility; 3 = medium credibility; 4 = high credibility; 5 = very high credibility.

(

b) Mean influence score is significantly greater than that listed immediately below, based on a t-test for related samples (p < 0.05).

(

c) Mean influence score is not significantly greater than that listed immediately below, based on a t-test for related samples (p > 0.05).

It is clear from Table 2 that the most credible information source is conference/ symposia with a mean score of 3.8. This suggests that on an average, it is perceived by respondents that the information disseminated through conference and symposia is having high credibility. Journals enjoy the second highest credibility with a score of 3.6. It also appears that both the information sources are scholarly in nature. Among promotional tools, medical representative stand next to conference/symposia as an information source, this is followed by samples and advertisements.

Testing of hypothesis H1a

It has been found that there exists a significant difference between credibility rating by physicians for various information sources on the basis of gender and hospital kind.

Gender

The data in Table 3 clearly shows that there exists no significant difference between the credibility attached by physicians on the basis of gender to various information sources except in the case of Medical Representative. This was achieved by recoding the data so that variables having responses 1 and 2 were clubbed as low credibility, 3 as medium credibility and 4 and 5 as high credibility. To ascertain whether gender and importance of information sources are independent, Pearson chi-square tests were applied. This implies that female physicians attach more credibility to medical representatives.

Table 3.

Relative credibility of information source according to gender of the respondents

Males			Females			Total			p Value of χ² test
L%	M%	H%	L%	M%	H%	L%	M%	H%
Conference/symposia	4.3	27.1	68.6	6.7	26.7	66.7	5.2	27.0	67.8	0.854
Journal	11.4	30.0	58.6	11.1	33.3	55.6	11.3	31.3	57.4	0.931
Clinical studies	22.9	34.3	42.9	31.1	33.3	35.6	26.1	33.9	40.0	0.580
Medical association	32.9	37.1	30.0	28.9	37.8	33.3	31.3	37.4	31.3	0.888
Medical representative	57.2	31.4	11.4	31.1	42.2	28.7	47.0	35.7	17.4	0.014
Co. website	44.3	38.6	17.1	40	40	20	42.6	39.1	18.3	0.880
Direct mail	47.1	35.7	17.1	44.4	31.1	24.4	46.1	33.9	20.0	0.624
Sample catch cover	58.6	22.9	18.6	57.8	22.2	20.0	58.3	22.6	19.1	0.982
Advertisement	74.3	17.1	8.6	55.6	26.7	17.8	67.0	20.9	12.2	0.104
Chemist	85.7	8.6	5.7	77.8	6.7	15.6	82.6	7.8	9.6	0.211
Level of significance 5%

L = low credibility 1-2; M = medium influence on rating 3; H = high influence on rating 4,5.

Hospital kind

Subsequently, Table 4 indicates that there exists significant difference between the credibility attached by physicians on the basis of hospital kind to various information sources except in the case of company website, medical association and conference.

Table 4.

Relative credibility of information sources according to hospital kind

Non-teaching government hospital			Non-teaching private hospital			Government teaching hospital			Private teaching hospital			None			p Value of χ²
L%	M%	H%	L%	M%	H%	L%	M%	H%	L%	M%	H%	None
Conference/symposia	0	16.7	83.3	7.7	38.5	53.8	7.3	18.2	74.5	0	30.4	69.6	0	60	40	.291
Journal	0	33.3	66.7	3.8	46.2	50	10.9	12.7	76.4	17.4	52.2	30.4	40	60	0	.00
Clinical studies
Medical association	50	16.7	33.3	26.9	46.2	26.9	27.3	36.4	36.4	39.1	43.5	17.4	40	0	60	.398
Medical representative	16.7	0	83.3	53.8	42.3	3.8	49.1	32.7	18.2	43.5	43.5	13.0	40	40	20	0.04
Co. website	33.3	16.7	50.0	38.5	38.5	23.1	45.5	43.6	10.9	43.5	34.8	21.7	40	40	20	.543
Direct mail	0	33.3	66.7	34.6	42.3	23.1	52.7	29.1	18.2	60.9	30.4	8.7	20	60	20	.041
Sample catch cover	0	0	100	61.5	30.8	7.7	72.7	10.9	16.4	43.5	43.5	13.0	20	40	40	.000
Advertisement	16.7	50.0	33.3	53.8	34.6	11.5	81.8	9.1	9.1	52.2	30.4	17.4	100	0	0	.008
Chemist	50.0	0	50	84.6	7.7	7.7	87.3	5.5	7.3	73.9	17.4	8.7	100	0	0	.037

L = low credibility 1-2; M = medium influence on rating 3; H = high influence on rating 4,5.

Relative perceptual influence of promotional tool on prescription behaviour

Table 5 depicts that the most influential promotion tool for physicians is conference/symposia with a mean value of 4.0. This suggests that most of the respondents opine that conference and symposia has got high influence on their prescription. Gifts have second-highest influence on prescription behavior whereas medical representatives stand third on the influence. Also t-test confirms that although the mean influence for conference and gifts were significant than the one succeeding it, this does not hold true for medical representative and advertisement. Thus, we cannot say whether the influence of medical representative is really higher than advertisement.

Table 5.

Influence of promotion tools on prescribing decisions

Promotion tools	Mean influence score (a)
Effect of promotion by educational programs on prescription	4.0 (b)
Effect of promotion by gifts on prescription	2.6 (b)
Effect of promotion by medical representative on prescription	2.3 (c)
Effect of promotion by advertisement on prescription	2.2 (c)
Effect of promotion by samples on prescription	2.2 (b)
Effect of promotion by other activities on prescription	1.8 (b)

(

a) Mean influence score is the average score on a 5-point scale, where 1 = no influence; 2 = low influence; 3 = medium influence; 4 = high influence; 5 = very high influence.

(

b) Mean influence score is significantly greater than that listed immediately below, based on a t-test for related samples (p < 0.05).

(

c) Mean influence score is not significantly greater than that listed immediately below, based on t-test for related samples (p > 0.05).

Testing of hypothesis H1b

It has been found that there exists a significant difference in the extent to which various promotional tools influence prescription on the basis of physician demographics.

Table 6 shows that there exists a significant relationship between the influence of promotion by medical representative and samples on physicians’ prescription behavior and the hospital type to which physicians belong. This implies that doctors among various hospital kinds like private teaching, private non-teaching, government teaching and government non-teaching have varied perception regarding the influence of medical representative and samples on prescription. Table 6 shows that influence on prescription behavior by promotion tools is not dependent on physicians’ age, qualification, specialty, practicing years and no. of prescriptions.

Table 6.

Promotional tools influence on prescription behavior and physicians’ demographics: One-way ANOVA

Age		Qualification		Specialty		Practicing years		No. of prescriptions		Kind of hospital
F	Sig.	F	Sig.	F	Sig.	F	Sig.	F	Sig.	F	Sig.
Effect of promotion by medical representative on prescription	2.224	.089	.577	.748	1.547	.099	1.179	.324	.148	.964	2.919	.024
Effect of promotion by Educational programs on prescription	.479	.698	.949	.464	.627	.855	1.626	.173	.452	.770	.437	.782
Effect of promotion by advertisement on prescription	1.126	.342	1.144	.342	.879	.594	.200	.938	.869	.485	.839	.503
Effect of promotion by samples on prescription	.249	.862	1.339	.246	.868	.607	.304	.874	.430	.787	3.751	.007
Effect of promotion by gifts on prescription	.168	.918	.341	.914	.793	.690	.308	.872	2.124	.083	.863	.488
Effect of promotion by other activities on prescription	1.823	.147	.582	.744	1.567	.093	.377	.824	.071	.991	2.553	.063

Correlation between influence of promotion tools on prescription and credibility of these promotional tools as information sources

Table 7 exhibits the correlations between importance given to promotion tools as an information source and extent to which it influences the prescription behavior. A low positive correlation was found between promotion tools and extent to which they influence prescription behavior.

Table 7.

Relationship between credibility of promotional tools as information source and perceived influence on prescription behavior: Correlation analysis

Effect of promotion by medical representative on prescription	Effect of promotion by Educational programs on prescription	Effect of promotion by advertisement on prescription	Effect of promotion by samples on prescription
MR’s credibility as an information source	.362(**)
Educational programs credibility as an information source	.085
Advertisements’ credibility as an information source	.256(**)
Sample catch cover as an information source	.362(**)

Correlation is significant at 0.01 level (2-tailed).

Conclusions and future research

This study examines the different types of promotion tools used by marketers for physicians and the perception of physicians about them. Though pharmaceutical firms may have been attempting to ascertain the influence of these tools at the firm level, there exists little published research in this area. This research addresses the paucity.

The findings of the study suggest several guidelines for managerial action. Conference and symposia have been indicated as the most preferred information source. Effect of promotion by educational programs on prescription has got highest rating. It is suggested that pharmaceutical marketers should focus more on educational programs like conferences and seminars to influence the physicians’ prescription behavior. The influence of promotion tools is primarily independent of demographic variables except in few cases. The study finds that physicians’ perception of promotional tools is related to the type of hospital to which the physician belongs. Pharmaceutical marketers need to keep this fact in mind while formulating promotional strategies for targeting physicians in different types of healthcare institutions.

There are some limitations to our study. Due to the type of repondent involved it was not feasible to cover a large data set. Snowball sampling was used to identify the respondents thus impacting the generalizability of the study. Further various aspects pertaining to individual promotion tools have not been taken up for examination. For example, knowledge and skills of medical representative would have a bearing on physicians’ responses. Future research could address this aspect in more detail. The study employs self-report perceptual measures. Further studies can attempt to examine the impact of various promotional tools in quantitative terms.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that they do not have any conflicts of interest.

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