INFLUENCE OF DIFFERENT MARKETING STRATEGIES ON

PRESCRIBING PATTERN OF PHYSICIANS IN PAKISTAN

By:
Ghulam Anbia Madni
M. Azeem Sarwar
Arsal Zaeem
Shi Xiaolin
 TABLE OF CONTENT
1. Introduction
1.1. Background of the study
1.2. Problem area
1.3. Problem statement
1.4. Aim of the study
1.5. Research objectives
1.6. Research questions
1.7. Delimitations of the study
2. Literature review
2.1. Concepts & definitions
2.2. Theoretical reflections
2.3. Evidences from the literature & Critical analysis of the literature
3. Proposed theoretical framework
3.1. Research Framework
3.2. Hypotheses
4. Proposed Research Methodology
4.1. Sample selection
4.2. Population frame
4.3. Unit of analysis
4.4. Type of study
4.5. Time horizon
4.6. Researcher’s strength
4.7. Instrument selection
4.8. Proposed data collection procedures
4.9. Proposed data analysis techniques
5. Schedule of Your Dissertation
5.1. Thesis completion time (GANTT chart)
6. Reference list
1. Introduction:
1.1. Background
Pharmaceutical marketing efforts directed to physicians are getting more and
more attention over the years. There are many tactics adopted by pharmaceutical
companies such as physicians-targeted promotions which are free samples, journal
advertisements, printed product literature and other gifts that helped them to
increase the acceptability of their products. On average, pharmaceutical
companies spent 20% or more of their sales on marketing which made them a lot
of money, and they had little incentive to stop those tactics. It was estimated that
84% of pharmaceutical marketing efforts are directed toward physicians because
from the manufacturer’s point of view, physicians are the key decision makers,
the gatekeepers to drug sales. The structure of pharmaceutical markets differs
from country to country because it has a national character. However, the
pharmaceutical industry has an international nature. To the best of our
knowledge, few published studies addressed the situation in the developing
world, and very few were those in the subcontinent.

1.2. Problem Area

If we analyze the marketing strategies offered by many pharmaceutical companies,

we can see that specificity and effectiveness is never measured and very little
research in developing nation like Pakistan is being done on this topic to point out
most effective marketing strategies to change the prescribing pattern of physicians.

1.2.1. Problem Statement

It is unclear that which marketing strategy is most effective in changing prescribing

pattern of physicians in Pakistan. Through this quantitative study we will explore and
try to figure out efficacy of different available marketing strategies.

1.3. Aim of study:

The aim of this study is to analyze which marketing strategy is effective in changing
the prescribing pattern of physicians.

1.4. Research Objectives:

i. To assess which marketing strategy is most effective in changing
prescribing pattern of physician.
 ii. To explore other factors that affect the changes in prescribing habits of
physicians
iii. To propose recommendations to pharmaceutical marketing industry about
most effective strategies in Pakistan.
1.5. Research Questions:
i. How marketing strategies used by pharmaceutical industry is influencing
the prescribing pattern of Physicians?
ii. Which marketing strategy has most effect on prescribing pattern of
Physician in Pakistan?
iii. How other factors like Physician’s age, Area of Practice, Location and
Hospital also influence the prescribing habits of Physician?
1.6. Delimitations of study:

There are certain delimitations of the study which are following.

i. Mediator and moderator effects are not incorporated as it will complicate

the study and main objective will become confusing.
ii. The physician number will be limited to 500 but they will be from diverse
areas in their field. As time frame is limited so cannot incorporate more
sample size.
iii. Ethical and unethical practices related to marketing will not be analyzed as
this is another aspect to study and can be studied separately.

2. Literature review
2.1. Concepts & Definitions:

The main concept is that physicians are influenced by certain marketing strategies
and it changes their prescribing pattern. Similar like other sectors, drug promotion
choices are taken to increase productivity of the company, by fulfilling the needs &
wants of the clients. It is quite simple in nonpharmaceutical sectors as the client
(consumer) can make up their mind to what item & in what requirements it should be
bought. In drug promotion, the client & the customers are two different individuals.
Even though the products are being bought by the patients for treating the infected
situation, the choice of what item that individual should the physician take purchase.
Therefore, the marketing policies are designed by keeping in view the consent of
customers' i.e. prescribing physicians, retail chemists & purchaser (customer) i.e.
patients.

Marketing Strategies: a plan of action designed to promote and sell a product or

service.

Prescribing Pattern: The extent and profile of drug use, trends, quality of drugs, and
compliance with regional, state or national guidelines like standard treatment
guidelines, usage of drugs from essential medicine list and use of generic drugs.

2.2. Theoretical Reflections:

Following theories could be applied in this research as they explain the behaviors
which are influenced in the research.

i. Adoption and Diffusion Theory: Physician prescribing pattern is a very

wide concept including various dimensions. In this research, the focus is
on the adoption of drugs. The process of adoption often is referred to as
the process of diffusion by which new ideas and products become adopted
by society
ii. Advertising theory: One of the main purposes of advertising is to entice the
consumer to purchase the product, that is to prescribe as this is ultimately
the metric against which pharmaceutical manufacturers measure success
or failure. Regardless of the role the physician occupied, in an
environment in which the chooser is not the user, he is still the target of
extensive pharmaceutical marketing within the context of advertising
theory.
iii. Agency theory: Agency theory serve this research well, as in an agency
relationship, the principal delegates the decision-making authority to an
agent to perform some action on the principal’s behalf. In the context of
the above definition, the manufacturer as principal depended on the
physician as the agent to select drugs from their specific offering. The
patient, in their role as principal, depended on the physician, acting as the
agent, to choose or prescribe the appropriate drug. Saying that the theory
of planned behavior is primordial to understand physicians’ behavior as it
 relates to prescribing, and often considering when attempting to modify or
influence physician prescribing.
iv. Role theory: It served as a link between agency theory and the theory of
planned behavior. It considered the foundations of the theory of planned
behavior which are based upon an individual’s attitude toward the
behavior, a perceived behavioral control and subjective norms and agency
theory, which focuses on principal-agent relationships. In this predefined
context, role theory thus permitted better management/understanding of
the dynamic aspects of the provider-client (agent-principal/physician-
manufacturer) interface and centers on role performance and the
interpersonal dimensions of service quality.
2.3. Evidences from the literature & Critical analysis of the literature:
The influence of promotional tools by pharmaceutical industry on prescribing
behaviors of doctors has a greater impact. The general promotional tools like gifts
etc. These are more influential rather than scientific promotional tools for the
physician contrast with consultants. Analyzed the effect of drug sample availability
on physician prescribing behavior. Based on their review, they investigate that most
accepted view that the medicines free samples are beneficial to the patients and
indirectly the good caring response come from the doctors from the free samples
that’s why it should be reconsidered. Examined the prescription behavior among
Medicare beneficiaries with capped prescription benefits. They find that the
prescription behavior has significant impact on the Medicare choices members. The
ethical activities from the medicine companies to the medical professionals through
communications by medical sales representatives. Small gifts such as pens,
notepads, pens, dinners sponsored by pharmaceutical companies, sponsorship to
the conferences and many other activities undertaken by physicians. Many doctors
do not consider accept small gifts as unethical and inputs such prescription affect its
structure. A doctor agrees that such activities by the pharmaceutical companies are
the indirect requirement of their drug prescriptions. The personalized pharmaceutical
marketing along with the facility of gifts and sponsorship to education recreational
activities. This research work conduced to find the donations and sponsorships
offered by the pharmaceuticals and reviews of doctors on it, that it is ethical or
unethical. Physicians are more towards the concern of ethical values and issues
contrary to residents. Physicians more eager and concern on the gifts and different
things provided from the pharmaceutical organizations for donations and
sponsorships at the start of their careers. The factors influencing prescription
behavior of physicians, discussed in the questionnaire are Price of the product,
Availability of the product, Communication made by MR the product quality that is
being promoted. Name of the company for which brand belongs to which company,
new research molecule and new research combination drug. Free of cost samples of
the drugs, free medical camps, product folders, Continuous Medical Education
(CME’s), Gifts & other promotional inputs, Research Molecule, Incentives,
Sponsorships to conferences. The conclusion shows that marketing strategies
related to 4Ps influence the physician prescription behavior in this study. The
mindset and the factors, which influences the prescribing behavior of physicians and
their practice in Greece and Cyprus and may be used for creating policies and
enhance their choices. The highlight of the study is that drug clinical effectiveness is
necessary element in prescribing medicine. Another research was conducted in
Denmark, which derived that price is also an important factor in prescribing drug and
on top of that Pharmaceutical industry, sales representative affects physician’s
behavior. Pharmaceutical organizations often use drug samples as a technique in
the ambulatory proper care establishing. Little is known about how the accessibility
to drug samples affects physicians’ prescribing methods. In this research of self-
reported doctor actions, avoiding cost to the individual was the most reliable
motivator for physicians to use drug samples, although physicians recognized other
advantages of drug samples that varied with the medical conditions. The recognized
advantages of drug samples often led physicians to review that they would distribute
or recommend medicine that differed from their preferred medication choice. The
financial rewards that had been suggested described or used regardless of their
preliminary purpose and, when possible, to evaluate the outcomes of these rewards
on expenses, procedure or outcomes of care Systematic review of the fictional
works. The effect of drug samples for the prescribing habits of family practice
citizens and staff for the therapy of hypertension. This research highlights the need
for a multi-facility research to figure out the impact of drug samples on prescribing
practices. Whether and how costs and marketing activities influence prescription
choice behavior using an extensive board of doctors and data on competitive cost
and marketing activities. The writers find that physicians are recognized by limited
cost understanding outlining and examples have a mostly useful effect on physicians
and physicians with a relatively large amount of Medical health insurance or health
maintenance organization patients are less affected by promotion than other
physicians.

3. Theoretical Framework.
3.1. Research Framework.

The following research framework explains that how our independent variables are
affecting the dependent variable.

Visit of Representative

Sales Call by Rep

Sponsorships to
Conferences
Drug Samples Prescribing Pattern
of Physicians

Medical Equipment as Gifts

Gifts and luxury items

Sponsored Leisure Trips

Dependent Variable
Independent Variables

3.2. Hypotheses:

i. H1. Visit of Sales representative is significant to prescribing pattern of

physicians.
 ii. H2. Sales Call by rep is significant to prescribing pattern of physicians.
iii. H3. Drug Samples is significant to prescribing pattern of physicians.
iv. H4. Medical Equipment as gift is significant to prescribing pattern of
physicians.
v. H5. Gifts and Luxury items is significant to prescribing pattern of
physicians.
vi. H6. Sponsored Leisure Trips is significant to prescribing pattern of
physicians.

4. Proposed Researched Methodology:

4.1. Sample Selection:

500 physicians from different specialties will be targeted and data will be collected
using questionnaires on google forms or WhatsApp or physical paper-based
questionaries’
4.2. Population Frame:
There are total around 185000 doctors in Pakistan out of which 46000 are specialists
in different fields but we cannot approach all of them at once so we will select the
pool of 500 specialists from different cities of Pakistan.
4.3. Unit of Analysis:
Doctors who are Specialists (FCPS Medicine) both male/female from different cities
of Pakistan.
4.4. Type of Study:
Quantitative study based on primary data collected through questionnaires and
analyzed through multiple linear regression.
4.5. Time Horizon of study:
Cross-sectional study which will be conducted between 2020-21 financial year.
4.6. Researchers Strength:
One of the researchers is working in Pharmaceutical sales so data collection will be
managed and two of the researchers have better understanding of SPSS, linear
regression and interpretation of data.
4.7. Instrument Selection:
Likert scale-based Questionnaires will be made using 5 or 7 points ranging from
strongly agree to strongly disagree.
4.8. Proposed Data Collection Procedure:
Data will be collected using google forms or paper based questionnaire.
 4.9. Proposed Data Analysis Technique:
SPSS will be used to manage and analyze the data. Results will be obtained by
using multiple linear regression. Multiple Linear Regression will be used to analyze
the data as this is primary data and independent and dependent variable relation is
to be analyzed.

5. Schedule of Dissertation:
Following Gantt Chart is showing proposed schedule of dissertation:
1-Aug 20-Sep 9-Nov 29-Dec 17-Feb 8-Apr 28-May

Questionnaire Preparation

Data Collection

Data Analysis

Write First Draft

Review Draft

Make Final Draft

Dissertation Due

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