Development and validation of an instrument designed to measure factors influencing physician prescribing decisions

Main Article Content

Keywords

Physicians, Pharmacists, Professional Practice, Practice Patterns, Physicians', Least-Squares Analysis, Reproducibility of Results, Validation Studies as Topic

Abstract

Background: Previous attempts to develop an instrument to measure factors that influence prescribing decisions among physicians were relatively insufficient and lacked validation scale.


Objective: We present a new tool that attempts to address this shortcoming. Hence, this study aims to develop and validate a self-administrated instrument to explain factors that influence the prescribing decisions of physicians.


Methods: The questionnaire was developed based on literature and then subjected to an exhaustive assessment by a board of professionals and a pilot examination before being administered to 705 physicians. Three pre-tests were carried out to evaluate the quality of the survey items. In pre-test 1, after items are generated and the validity of their content is assessed by academics and physicians. In pre-test 2, the scale is carried out with a small sample of 20 respondents of physicians. In pre-test 3, fifty drop-off questionnaires were piloted amongst physicians to test the reliability.


Results: On the basis of partial least squares structural equation modelling (PLS-SEM) analyses using SmartPLS 3, the content and convergent validity of the instrument were confirmed with 44 items grouped into four categories, namely, marketing efforts, patient characteristics, pharmacist variables, and contextual factors with 13 reflective constructs.


Conclusions: The study outcomes prove that the scale is more valid and reliable for measuring factors that influence the decision of the physician to prescribe the drug. The development and presentation of a scale of thirteen factors related to physicians prescribing decisions help to ensure valid findings and facilitates comparisons of studies and research settings.

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References

1. Al-Areefi MA, Hassali MA, Ibrahim MI. The role of pharmaceutical marketing and other factors in prescribing decisions: the Yemeni experience. Res Social Adm Pharm. 2013;9(6):981-988. https://doi.org/10.1016/j.sapharm.2012.10.006
2. Kotwani A, Wattal C, Katewa S, Joshi P, Holloway K. Factors influencing primary care physicians to prescribe antibiotics in Delhi India. Fam Pract. 2010;27(6):684-690. https://doi.org/10.1093/fampra/cmq059
3. Grindrod KA, Patel P, Martin JE. What interventions should pharmacists employ to impact health practitioners' prescribing practices? Ann Pharmacother. 2006;40(9):1546-1557. https://doi.org/10.1345/aph.1G300
4. Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic review of interventions to improve prescribing. Ann Pharmacother. 2009;43(3):502-513. https://doi.org/10.1345/aph.1L488
5. Clyne B, Fitzgerald C, Quinlan A, Hardy C, Galvin R, Fahey T, Smith SM. Interventions to address potentially inappropriate prescribing in community-dwelling older adults: A systematic review of randomized controlled trials. J Am Geriatr Soc. 2016;64(6):1210-1222. https://doi.org/10.1111/jgs.14133
6. Neyaz Y, Qureshi, NA, Khoja T, Magzoub MA, Haycox A, Walley T. Physicians ’ medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 1 : variations in drug prescribing. East Mediterr Health J. 2011;17(2):126-131.
7. Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci. 2008;3:36. https://doi.org/10.1186/1748-5908-3-36
8. Oshikoya KA, Oreagba I, Adeyemi O. Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria. Pan Afr Med J. 2011;9:13. https://doi.org/10.4314/pamj.v9i1.71188
9. Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, Vitry AI. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: A systematic review. PLoS Med. 2010;7(10):e1000352. https://doi.org/10.1371/journal.pmed.1000352
10. Murshid MA, Mohaidin Z. The influence of information, brand, medical representatives and sales promotion on physician prescribing decision. J Pharm Health Serv Res. 2018;9(3):259-269. https://doi.org/10.1111/jphs.12228
11. Murshid MA, Mohaidin Z, Nee GY.The influence patient’s characteristics “requests and expectations” on physician prescribing behavior: A review. Int J Pharm Health Mark. 2016;10(4):390-411. https://doi.org/10.1108/IJPHM-01-2016-0010
12. Joyce GF, Carrera MP, Goldman DP, Sood N. Physician prescribing behavior and its impact on patient-level outcomes. Am J Manag Care. 2011;17(12):e462-e471.
13. Tušek-Bunc K, Kersnik J, Petek-Šter M, Petek D, Klemenc-Ketiš Z. Explanatory model of prescribing behavior in prescription of statins in family practice. Wien Klin Wochenschr. 2010;122(Suppl 2):79-84. https://doi.org/10.1007/s00508-010-1336-y
14. Arney J, Street RL, Naik AD. Factors shaping physicians’ willingness to accommodate medication requests. Eval Health Prof. 2014;37(3):349-365. https://doi.org/10.1177/0163278712468756
15. Lee D. Prescription drug request and denial. Int J Pharm Health Mark. 2012;6(3):200–214. https://doi.org/10.1108/17506121211259386
16. Murshid MA, Mohaidin Z. Models and theories of prescribing decisions: A review and suggested a new model. Pharm Pract (Granada). 2017;15(2):990. https://doi.org/10.18549/PharmPract.2017.02.990
17. Ladeira W, Dalmoro M, Maehler AE, Falcão Araujo C. Drug prescription practices in Brazil: a structural equation model. Int J Pharm Health Mark. 2011;5(4):262-278. https://doi.org/10.1108/17506121111190103
18. Kremer S, Bijmolt T, Leeflang P, Wieringa JE. Generalizations on the effectiveness of pharmaceutical promotional expenditures. Int J Res Mark. 2008;25:234-246. https://doi.org/10.1016/j.ijresmar.2008.08.001
19. Mehralian G, Sharif Z, Yousefi N, Akhgari M. Physicians’ loyalty to branded medicines in low-middle-income countries: A structural equation modeling. J Generic Med. 2016;13(1):9-18. http://doi.org/10.1177/1741134316673227
20. Murshid MA, Mohaidin Z, Nee GY. Moderating effects of contextual factors on relationship between pharmaceutical marketing strategies and physician prescription decision: A review. Trop J Pharm Res. 2016;15(7):1559-1568. http://doi.org/10.4314/tjpr.v15i7.28
21. Murshid MA, Mohaidin Z, Nee GY. Influence of pharmacists expertise on physicians prescription decisions. Trop J Pharm Res. 2016;15(7):1549-1557. http://doi.org/10.4314/tjpr.v15i7.27
22. Basak R, Bentley JP, Mccaffrey DJ, Bouldin AS, Banahan BF.The role of perceived impact on relationship quality in pharmacists’ willingness to influence indication-based off-label prescribing decisions. Soc Sci Med. 2015;132:181-189. https://doi.org/10.1016/j.socscimed.2015.03.028
23. Kucukarslann S, Lai S, Dong Y, Al-Bassam N, Kim K. Physician beliefs and attitudes toward collaboration with community pharmacists. Res Social Adm Pharm. 2011;7(3):224-232. https://doi.org/10.1016/j.sapharm.2010.07.003
24. Hager KD, Uden D, Tomaszewski D. Bridging the location gap : physician perspectives of physician-pharmacist collaboration in patient care( BRIDGE Phase II). J Res Interprof Pract Educ. 2015;5(2):1-14. http://doi.org/10.22230/jripe.2015v5n2a199
25. Murshid MA, Mohaidin Z. Influence of the expertise, collaborative efforts and trustworthiness of pharmacists on the prescribing decisions of physicians. J. Pharm. Pract. Res. 2019;49(2):150-161. https://doi.org/10.1002/jppr.1492
26. Abdul Waheed K, Jaleel M, Laeequddin M. Prescription loyalty behavior of physicians: an empirical study in India. Int J Pharm Health Mark. 2011;5(4):279-298. https://doi.org/10.1108/17506121111190112
27. Janakiraman R, Dutta S, Sismeiro C, Stern P. Physicians’ persistence and its implications for their response to promotion of prescription drugs. Manag Sci. 2008;54(6):1080-1093. https://doi.org/10.1287/mnsc.1070.0799
28. Handa M, Vohra A, Srivastava V. Perception of physicians towards pharmaceutical promotion in India. J Med Market. 2013;13(2):82-92. https://doi.org/10.1177/1745790413480519
29. Sanyal NS, Datta SK, Banerjee KA. Factors influencing prescribing decisions among physicians: an empirical study on generic drugs. Int J Pharm Health Mark. 2017;11(4):330-360. https://doi.org/10.1108/IJPHM-06-2016-0031
30. Pedan A, Wu H. Asymmetric responsiveness of physician prescription behavior to drug promotion of competitive brands within an established therapeutic drug class. Health Mark Q. 2011;28(2):133–54. https://doi.org/10.1080/07359683.2011.545341
31. Theodorou M, Tsiantou V, Pavlakis A, Maniadakis N, Fragoulakis V, Pavi E, Kyriopoulos J. Factors influencing prescribing behavior of physicians in Greece and Cyprus: results from a questionnaire-based survey. BMC Health Serv Res. 2009;9:150. https://doi.org/10.1186/1472-6963-9-150
32. Wensing M, Broge B, Riens B, Kaufmann-Kolle P, Akkermans R, Grol R, Szecsenyi J. Quality circles to improve prescribing of primary care physicians. Three comparative studies. Pharmacoepidemiol Drug Saf. 2009;18(9):763-769. https://doi.org/10.1002/pds.1778
33. Venkataraman S, Stremersch S. Erratum the debate on influencing doctors’ decisions: are drug characteristics the missing link? Manag Sci. 2007;54(1):1688-1701. https://doi.org/10.1287/mnsc.1070.0718
34. Kersnik J, Peklar J. Attitudes of Slovene general practitioners to- wards generic drug prescribing and comparison with interna- tional studies. J Clin Pharm Ther. 2006;31(6):577-583. https://doi.org/10.1111/j.1365-2710.2006.00776.x
35. Rashidian A, Russell I. General practitioners ’ intentions and prescribing for asthma: using the theory of planned behavior to explain guideline implementation. Int J Prev Med. 2012;3(1):17-28.
36. Shrank W, Joseph G, Choudhry N, Young H, Ettner S, Glassman P. Physicians’ perceptions of relevant prescription drug costs: do cost to the individual patient or the population matter most? Am J Manag Care. 2006;12(9):545-551.
37. Khan S, Sylvester R, Scott D, Pitts B. Physicians’ opinions about responsibility for patient out-of-pocket costs and formulary prescribing in two Midwestern states. J Manag Care Pharm. 2008;14(8):780-789. https://doi.org/10.18553/jmcp.2008.14.8.780
38. Hartono S, Sumarwan U, Suharjo B. Model of physician decision-making process on prescribing prescription drug in Indonesia. Int J Inform Technol Business Manag. 2014; 24(1):1-10.
39. Murshid MA, Mohaidin Z. A systematic review of the influence of medical representatives and promotional tools on prescribing: A comparison between developed and developing countries. Int J Pharm Health Mark. 2017;11(4):361-394. https://doi.org/10.1108/IJPHM-09-2016-0047
40. Epstein AJ, Ketcham JD. Information technology and agency in physicians ’ prescribing decisions. Rand J Econ. 2014;45(2):422-448. https://doi.org/10.1111/1756-2171.12057
41. Gonul FF, Carter FJ, Petrova E, Srinivasan K. Promotion of prescription drugs and its impact on physicians’ choice behavior. J Market. 2001; 65(7):79-90.
42. Saito S, Mukohara K, Bito S. Japanese practicing physicians’ relationships with pharmaceutical representatives: A national survey. PLoS One. 2010;5(8):e12193. https://doi.org/10.1371/journal.pone.0012193
43. Zahrani H. The impact of pharmaceutical promotions on primary health care physician\s prescribing behaviour in KAMC in the central region. Int J Med Sci Public Health. 2014;3(3):355. https://doi.org/10.5455/ijmsph.2014.150120141
44. Al-Areefi MA, Ibrahim MI, Hassal MA, Alfadl AA. Perceptions of Yemeni physicians about interactions with medical representatives J Pharm Health Serv Res. 2017;8(4):255-260. https://doi.org/10.1111/jphs.12195
45. Parker RS, Pettijohn CE. Pharmaceutical drug marketing strategies and tactics : a comparative analysis of attitudes held by pharmaceutical representatives and physicians. Health Mark Q. 2005;22(4):27-43. https://doi.org/10.1300/J026v22n02_03
46. Karayanni D. A cluster analysis of physician’s values, prescribing behaviour and attitudes towards firms’ marketing communications. : Int J Cust Relat Mark Manag. 2010;1(4):62-79. https://doi.org/10.4018/jcrmm.2010100104
47. Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, Evans RG, Pan R, Marion SA. Influence of direct to consumer pharmaceutical advertising and patients’ requests on prescribing decisions: two site cross sectional survey. BMJ. 2002;324(7332):278-279. https://doi.org/10.1136/bmj.324.7332.278
48. Britten N, Ukoumunne O. The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire study. BMJ. 1997;315(7121):1506-1510. https://doi.org/10.1136/bmj.315.7121.1506
49. Adorka M, Dikokole M, Mitonga KH, Allen K. Healthcare providers’ attitudes and perceptions in infection diagnosis and antibiotic prescribing in public health institutions in Lesotho: A cross-sectional survey. Afr Health Sci. 2013;13(2):344-350. https://doi.org/10.4314/ahs.v13i2.21
50. Littile TD, Bovaird JA, Wianaman KF. On the merits of orthogonalizing powered and product terms: implications for modeling interactions among latent variables. Struct Equ Modeling. 2006;13(4):497-519. https://doi.org/10.1207/s15328007sem1304_1
51. Hoffman D, Nelson R, Kleinschmidt I. An assessment of factors influencing the prescribing of antibiotics in Acute Respiratory Illness : A questionnaire study. S Afr Fam Pract. 2003;45(6):20-24.
52. Moore T, Kennedy J, McCarthy S. Exploring the General Practitioner-pharmacist relationship in the community setting in Ireland. Int J Pharm Pract. 2014;22(5):327-334. https://doi.org/10.1111/ijpp.12084
53. Shakeel S, Iffat W, Fasih F, Yousuf YN. Pharmaceutical care and health systems expanding role of pharmacists in delivering clinical services ; general practitioners ’ and pharmacists ’ viewpoint. Pharm Care Health Syst. 2015;2(5):2-6.
54. Tahaineh LM, Wazaify M, Albsoul-Younes A, Khader Y, Zaidan. Perceptions, experiences, and expectations of physicians in hospital settings in Jordan regarding the role of the pharmacist. Res Social Adm Pharm. 2009;5(1):63-70. https://doi.org/10.1016/j.sapharm.2008.05.003
55. Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists. Res Social Adm Pharm. 2013;9(6):688-699. https://doi.org/10.1016/j.sapharm.2012.12.005
56. Zillich AJ, Doucette WR, Carter BL, Kreiter CD. Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective. Value Health. 2005;8(1):59-66. https://doi.org/10.1111/j.1524-4733.2005.03093.x
57. Liu Y, Doucette WR, Farris KB. Examining the development of pharmacist-physician collaboration over 3 months. Res Social Adm Pharm. 2010;6(4):324-333. https://doi.org/10.1016/j.sapharm.2009.11.002
58. Yüksel A. A critique of “Response Bias” in the tourism, travel and hospitality research. Tour Manag. 2017;59:376-384. https://doi.org/10.1016/j.tourman.2016.08.003
59. Armstrong JS, Overton, TS. Estimating nonresponse bias in mail surveys. J Mark Res. 1977;14(3):396-402. https://doi.org/10.1177/002224377701400320
60. Vatcheva KP, Lee M, McCormick J, Rabhar M. Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology (Sunnyvale). 2016 Apr;6(2):227. https://doi.org/10.4172/2161-1165.1000227
61. Hair JF, Hult GT, Ringle CM, Sarstedt M, Thiele KO. Mirror, mirror on the wall: A comparative evaluation of composite-based structural equation modeling methods. J Acad Mark Sci. 2017;45:616-632. https://doi.org/10.1007/s11747-017-0517-x
62. Ramayah T, Jacky Cheah, Francis Chuah, Hiram Ting, Mumtaz Ali Memon. Partial Least Squares Structural Equation Modeling (PLS-SEM) Using SmartPLS 3.0: An Updated Guide and Practical Guide to Statistical Analysis. Kuala Lumpur: Pearson; 2016.
63. Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci. 2015;43(1):115-135. https://doi.org/10.1007/s11747-014-0403-8
64. Avkiran NK. An in-depth discussion and illustration of partial least squares structural equation modeling in health care. Health Care Manag Sci. 2018;21(3):401-408. https://doi.org/10.1007/s10729-017-9393-7
65. Henseler J. Bridging design and behavioral research with variance-based structural equation modeling. J Advert. 2017;46(1):178-192. https://doi.org/10.1080/00913367.2017.1281780
66. Wetzels M, Schroder GO, Oppen VC. Using PLS path modeling for assessing hierarchical construct models: Guidelines and empirical illustration, MIS Q. 2009;33(1):177-195. https://doi.org/10.2307/20650284
67. Hair JF, Hult GT, Ringle CM, Sarstedt M. A primer on partial least squares structural equation modeling (PLS-SEM), 2nd ed. Thousand Oaks: Sage; 2016.
68. Sanyal NS, Datta SK, Banerjee KA. Conceptualisation of branding: strategy based on the Indian pharma sector. Int J Pharm Health Mark. 2013;7(2):175-198. https://doi.org/10.1108/IJPHM-04-2013-0013
69. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open. 2017;7(9):e016408. https://doi.org/10.1136/bmjopen-2017-016408
70. Stremersch S, Landsman V, Venkataraman S. The relationship between DTCA, drug requests, 91 and prescriptions: uncovering variation in specialty and space. Mark Sci. 2013; 32(1):89-110. https://doi.org/10.1287/mksc.1120.0757
71. Kim WJ, King KW. Product category effects on external search for prescription and nonprescription drugs. J Advert. 2009:38(1):5–20. https://doi.org/10.2753/JOA0091-3367380101
72. Pinto JC, Silva AF, Curto JD. Determinant values in the medical act of prescribing in the Portuguese context. J Med Market. 2010;10(3),213-230. https://doi.org/10.1057/jmm.2010.11