Socioecological factors linked with pharmaceutical incentive-driven prescribing in Pakistan

Abstract

Pharmaceutical marketing through financial incentivisation to general practitioners (GPs) is a poorly studied health system problem in Pakistan. Pharmaceutical incentivisation is seen to be distorting GPs prescribing behaviour that can compromise the health and well-being of patients. We draw on a conceptual framework outlined in the ecological system theory to identify multiple factors linked with pharmaceutical incentivisation to GPs in Pakistan. We conducted qualitative interviews with 28 policy actors to seek their views on the health system dynamics, how they sustain pharmaceutical incentivisation and their effect on the quality of care. Our analysis revealed four interlinked factors operating at different levels and how they collectively contribute to pharmaceutical incentivisation. In addition to influences such as the increasing family needs and peers’ financial success, sometimes GPs may naturally be inclined to maximise incomes by engaging in pharmaceutical incentivisation. On other hand, the pharmaceutical market dynamics that involve that competition underpinned by a profit-maximisation mindset enable pharmaceutical companies to meet GPs’ desires/needs in return for prescribing their products. Inadequate monitoring and health regulations may further permit the pharmaceutical industry and GPs to sustain the incentive-driven relationship. Our findings have important implications for potential health reforms such as introducing regulatory controls, and appropriate monitoring and regulation of the private health sector, required to address pharmaceutical incentivisation to GPs.

Healthcare Consumers’ Perceptions of Incentive-Linked Prescribing: A Scoping Review of Research

“…This finding is consistent with several empirical studies with physicians, pharmaceutical companies, and other relevant stakeholders who testify to the unethical exchanges between physicians and pharmaceutical companies in various parts of the world. (4, 8, 13, 35, 36) This means that even though physicians and pharmaceutical companies may attempt to establish financial ties discretely, HCCs have a reasonable awareness of this practice.…”

“…A protocol to conduct this scoping review was registered with Open Science Framework. (15) We used a five-stage framework developed by Arksey and O’Malley. These stages include identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results.…”

“…Consequently, incentive-linked prescribing (ILP) may negatively affect patients' health or exacerbate their financial difficulty. (4)(5)(6) In recent years, there has been a steady stream of published studies about ILP from different parts of the world (5)(6)(7)(8). However, most of this work is based on research with physicians, the pharmaceutical industry, and other relevant stakeholders (i.e., regulators or nongovernmental organisations) rather than documenting the perspectives of HCCs.…”

Uncertainties about the quality of medical products globally: lessons from multidisciplinary research

“…Third, the remaining articles present national case scenarios of global relevance. Noor et al presented the findings of a study in Pakistan, which reveals and explains the potential distortion of prescribing behaviour, caused by pharmaceutical marketing and financial incentivisation to general practitioners 11. Hamill et al drew on interviews with manufacturers and regulators in India to investigate the under-studied issue of quality of active pharmaceutical ingredients, and called for increased attention to the risks of regulatory circumvention 12.…”

“…Noor et al presented the findings of a study in Pakistan, which reveals and explains the potential distortion of prescribing behaviour, caused by pharmaceutical marketing and financial incentivisation to general practitioners. 11 Hamill et al drew on interviews with manufacturers and regulators in India to investigate the under-studied issue of quality of active pharmaceutical ingredients, and called for increased attention to the risks of regulatory circumvention. 12 Nistor et al discussed how political and economic factors influence the risk of falsified medicines in Romania: they warned against exclusive focus on enforcing quality-assurance, reminding that ensuring access to affordable medicines is equally critical to eliminate the factors that incentivise falsified medicines.…”