Introduction: Pakistan is the 6 th most populous country in the world and has an enormous potential for an ever increasing drug market. The health care system is highly prone to unethical drug prescribing practices. In addition, there is a huge tendency of pharmaceutical firms to indulge in unethical drug promotional practices by means of inducements and other benefits through their medical sales representatives (MSRs). On the other hand, the prescribers are also reported to be demanding inducements from these companies in return to write higher number of prescription. This study investigated the ground realities of drug promotion and prescribing practices in Pakistan. Materials and Methods: A cross sectional study was conducted for a period of 8 months in which 472 physicians and 609 medical sales representatives of Pakistan selected through prospective sampling were interviewed on a validated, structured questionnaire. The responses of the target groups were then analyzed for association between variables by Chi-square test (p<0.05) and cross tabulation through SPSS, version 20. Results: Majority of practitioners (83.2%) expected both, good communication skills and knowledge from MSRs and at the same time nearly half (53%) of prescribers demanded CME and almost a third proportion (36%) demanded gifts, incentives and inducements from MSRs. Replying to same question, MSRs disagreed with prescribers and believed that around (~70%) of prescribers ask for inducements with a high percentage i.e. (~64%) among them demanding unethical inducements like excessive free samples, gifts, leisure trips and cars. Majority of physicians (92%) have consensus that the multinational pharmaceutical firms have defined promotional practices while the national pharmaceutical companies (~73%) are mainly involved in unethical practices of drug marketing. Conclusion: Majority of national pharmaceuticals as well as prescribers were involved in unethical drug promotion and prescribing respectively. There is a need of curbing the unethical drug promotion and prescribing and formidable policies governing this issue are required to be implemented by the concerned regulatory authorities to avoid unnecessary harm to the patient's life and pocket. Strength and weakness of study: The study explored the drug promotion and prescribing practices for the first time in a developing country however, due to sensitivity of the topic a number of respondents hesitated to participate.
Background: Pharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist's role as healthcare professional is limited. This study aimed to document pharmacists' attitude towards their role in Pakistan's healthcare system, their experience with doctors and their perceptions towards involvement in medicines management. Methods: A 4-month cross-sectional survey (Jan-Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ 2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists' attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer's V ≥ 0.3 was considered cutoff for establishing statistical significance. The study was approved by ethical committee and local hospital committees. Results: Three hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors. Conclusion: Pharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist's role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan's healthcare system.
The inclusion of pharmacists in the healthcare system of a developing country like Pakistan has always been a subject of debate among the healthcare professionals (HCPs), especially physicians, who have long ruled the healthcare system alone and who have had a long-held position of supremacy. The common argument against the inclusion of pharmacists is the dynamics of the healthcare system, and patients being physician oriented, hence, consider the inclusion of pharmacists as no good. Although the trend of defiance is changing, it is worthwhile mentioning here that the concept of the inclusion of pharmacist was implemented in developed countries by an evidence-based approach, i.e., to actually involve pharmacists in the disease state management of a patient and conducting a trial. This opinion calls for the same to be implemented in a developing country like Pakistan to evaluate its significance.
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