الفهرس 
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Abstract
The interaction and potential conflicts of interest between physicians and the pharmaceutical industry has been increasingly noticed. Conflict of interest arises when primary ethical or professional interest of physician is compromised by self or financial interest.
Pharmaceutical companies use promotional tools and gifts to affect the prescribing behavior of physicians. Studies showed that the majority of the interaction between physician and pharmaceutical industry had negative results on clinical care.
Objectives of the study:
1- To estimate the extent of exposure of physicians to the pharmaceutical industry’s marketing practices.
2- To identify the different kinds of marketing practices presented to physicians by pharmaceutical industries.
3- To assess the perspective of physicians regarding these practices and how they affect their clinical decisions.
Subjects and methods:
A cross-sectional design was used. The study was conducted at governmental general hospitals in Alexandria. The target population was physicians in governmental general hospitals in Alexandria. Using Epi-info version 7.1.5.2, 2015, the sample size was calculated and based on the assumption of a 50% of physicians are exposed to the pharmaceutical industry, confidence limit of 5% around the expected prevalence, a 95% level of confidence, the minimum required sample size was 384,and it was rounded to 400 physicians. A simple random technique was used to recruit physicians for the study.
The data collection tools included:
A pre designed structured, self-administered anonymous questionnaire was introduced to physicians inside a closed envelope to eliminate any bias and conflict of interest, and included the following:
• Personal and professional data.
• Data about frequency of exposure to pharmaceutical industry and their marketing activities.
• Data about physicians’ perspective regarding the impact of pharmaceutical companies’ marketing activities on their prescribing behavior.
• Data about physicians’ perspective about what kind of pharmaceutical industries’ activities that benefit patients.
Results:
Section1: Description of the study sample:
• Physicians’ age ranged from 25 to 60 years, with mean age 35.2 ± 7.6 years, and the median age was 33 years. Regarding physicians’ sex 58.5% and 41.5% of physicians were males and females, respectively. The study showed that 26.5% of physicians were single. Regarding the specialty of physicians, 20.5%, 10.8%, 29.0%, 22.8%, 11.5% and 5.5% of physicians were general practitioners (GP), internal medicine (IM), Pediatricians, gynecologists, orthopedic surgeons and general surgeons, respectively. The study showed that 81.8% of physicians were attending doctors while only 18.2% of them were residents. 58.8% of physicians in the sample owned a private clinic while 41.2% of them did not. Most of physicians attended educational programs (84.2%). Regarding post graduate studies, only 19.2% of physicians did not have any post graduate studies, while 12.0%, 65.0% and 3.8% of them had diploma, master and doctorate respectively.
Section 2: The extent of physicians’ exposure to and kind of pharmaceutical industry’s marketing practices
• About two thirds of physicians (60%) were visited by medical representatives more than 5 times per month. More than half of physicians (57.8%) received medical samples in more than 5 occasions each month. Most physicians (72.8%) received promotional materials more than 5 times per month. Only 26.2% of physicians did not get registered for conferences by pharmaceutical companies, while 53.8% of them were registered once per year for conferences and 20% of them got registered for more than once yearly. Vast majority of physicians (98%) denied that they received incentives from pharmaceutical companies in exchange for their drug recommendation. Regarding the type of pharmaceutical companies 72% of physicians reported that they got visits from both national and international pharmaceutical companies, and only 9.8% of physicians got visited by international companies only. When it comes to the type of pharmaceutical companies financing conferences registration, 40.8% of physicians stated that international companies are the ones financing conferences registration, while 9.5% of physicians said that national companies were the sponsors for conference registration and 23.5% of physicians stated that both national and international companies made registration sponsorship for conferences.
Section 3: The perspective of physicians regarding pharmaceutical industry’s marketing practices and how they affect their clinical decisions and benefit patients
• Concerning physicians’ perspective regarding the impact of pharmaceutical companies’ marketing activities on their prescribing behavior, medical samples, medical practice related materials, learning materials and continuous medical education had the highest percentages of responses with 20.6%, 20.1%, 21%, and 20.2% respectively. While promotional materials and gifts not related to practice had the lowest responses with percentages of 9.5% and 8.4% respectively.
• Regarding physicians’ perspective pharmaceutical industries’ activities that benefit patients, medical samples had the highest percentage (25.1%) of responses, followed by medical practice related materials, continuous medical education and learning materials, with percentages of 23.7%, 20.5% and 19.1% respectively.
Section 4: prevalence and determinants of pharmaceutical companies’ incentives and their effect on physicians’ prescribing behavior:
• No significant difference was observed between age groups and sex regarding pharmaceutical incentive scores (p = 0.274 and 0.390) respectively.
• Regarding marital status, married physicians were of three medium and high incentive score as that of single ones. The association was statistically significant (p = 0.000).
• Physicians who own a private clinic had about twelve times incentive score compared to those who did not own. The association was statistically significant (p = 0.000).
• No significant difference was observed between years in practice, specialty, number of continued education programs and post graduate studies
• (p = 0.329, 0.761, 0.318 and 0.505) respectively.
• Physicians of no position had about two and half times medium and high incentive score compared to those of positions. The association was statistically significant (p = 0.005).
• Logistic regression analysis showed that position and owing private clinics had a significant impact on incentive score. The ROC curve of probability of medium and high incentive score calculated from binary logistic regression model among physicians shows that the area under the curve (AUC) was 0.743 (CI 0.691, 0.794 and p = 0.000).
• Physicians who have diploma and owing private clinics their prescribing behavior was significantly affected by receiving promotional incentives from pharmaceutical companies. The association was statistically significant (p= .0000 and 0.001) respectively.
• Physicians with low incentives score their prescribing behavior were not affected. The association was statistically significant (P =0.002).
• Logistic regression analysis shows that medium and high incentive score, diploma and owing a private clinic had a significant impact on prescribing behavior. 556 (P =0.001, 0.000 and 0.002) respectively.
• Age (p= 0.000), marital status (p= 0.002), years in practice (p= 0.028), specialty (p= 0.000), position (p= 0.000), owning a private clinic (p= 0.003), postgraduate studies (p = .000) and behavioral scores (p = .024) had a significant relation with the physician’s point of view about marketing activities of pharmaceutical companies that may benefit patients. The logistic regression shows that specialty and postgraduate studies had a significant impact on the physician’s point of view about marketing activities of pharmaceutical companies that may benefit patients. The ROC curve of probability of high patient benefit score calculated from binary logistic regression model among physicians shows that the area under the curve (AUC) was 0. 636 (CI 0.636, 0.690 and (p = 0.000).
Conclusion:
• Being a resident and owing a private clinics have a significant impact on incentive score
• Physicians who have diploma and owing a private clinics their prescribing behavior is significantly affected by receiving materials
• physicians with low incentives score had a higher medium and high score not affecting their prescribing behavior
• Age, marital status, years in practice, specialty, position, owning a private clinic, postgraduate studies and behavioral score had a significant relation with the physician’s point of view about marketing activities of pharmaceutical companies that may benefit patients
• Specialty and postgraduate studies had a significant impact on the physician’s point of view about marketing activities of pharmaceutical companies that may benefit patients
Recommendations:
A cooperation of efforts must be established between physicians, ethically promoting companies and national health care regulatory bodies to eliminate any conflict of interest that may arise from the interaction between physicians and pharmaceutical companies. Ensuring that physicians stick to the code of professional ethics and sticking of pharmaceutical companies to the code of business conducts, is crucial. Prioritization of patient’s benefits over any personal benefits of physicians or pharmaceutical companies is a must, and extreme penalties should be applied on those who do not comply.