A Qualitative Study of Influences on Thai Physicians' Prescribing of Promotional Targeted Drugs
Objectives: To explore Thai physicians' perception toward promotional targeted drug (PTD) prescribing and the factors that influence them to prescribe a PTD.
Methods: A qualitative study was conducted using various data triangulation approaches including documentary analysis, in-depth interviews of physicians as well as other key informants in the pharmaceutical industry, and observation when participating in medical conferences. To obtain optimal theoretical sampling and saturation during the data collection and analysis, approaches in Grounded Theory were applied.
Results: Overall, the physicians had a positive perception toward the PTD itself in terms of the innovative product profile that could benefit the patients. Nevertheless, most doctors had concerns about prescribing PTD, particularly the long-term safety of PTD and issues related to the entangling relationship between doctor and pharmaceutical industry, especially when the pharmaceutical companies spent a lot on marketing PTD. The individual doctor's prescribing pattern could be explained as his/her defense mechanism when facing the conflict between professional and ethical practice, which forms the basis of our newly developed- 'Symbiosis Ethical Balance Model.' Factors related to prescribing PTD were intricate, multidimensional and could vary with different types of patients, practice site, and physician's background.
Conclusions: Based on the grounded empirical data using various qualitative methods, we uncovered the complex PTD prescribing phenomena thereby providing insights into how the physicians make sense of their PTD prescribing; their exposure to tactical promotion activities; and the situational defensive responses of physicians in their real practices, which are not easily reflected by the traditional quantitative research approach. Our Symbiosis Ethical Balance Model elaborates the interplay of factors influencing physicians' prescribing behavior of PTDs, an understanding of which is essential for developing practical policies in order to promote rational drug use and curb increase in drug costs in Thailand.