Marys Medicine


Assessing the impact of pharmaceutical communication channels on general practitioners' drug prescribing intentions

Inzinerine Ekonomika-Engineering Economics, 2015, 26(5), 541–550
Revisiting the Role of Traditional, Electronic and Mobile-Based Communication
Channels in the Pharmaceutical Industry of Lithuania

Vilte Auruskeviciene1, Jovita Butkeviciene2, Laura Salciuviene3

1,2ISM University of Management and Economics
Arkliu st. 18, LT-01305, Vilnius, Lithuania
[email protected]
3Lancaster University Management School
Lancaster, LA1 4YX, United Kingdom,

The study investigates communication channels currently used to disseminate medical information and examines perceptions of general practitioners (GPs) about perceived value, perceived reliability and channel usage frequency of traditional and alternative (i.e., electronic and mobile-based) channels. A total of 254 GPs in Lithuania were surveyed. The findings suggest that pharmaceutical companies still rely on sales representatives to disseminate the newest information about prescription drugs to GPs. The results suggest that leading experts (i.e., opinion leaders) in the healthcare industry add significantly to increasing GPs' intentions to prescribe specific drugs to their patients. Conferences organised by local and international scientific societies are considered to be the most reliable communication channels. Local websites designed for GPs have the highest perceived value among GPs. Further, statistically significant differences among different GPs' age groups were confirmed regarding channel preference and their perceived reliability: international scientific conferences and international health journals were more popular and perceived as more reliable among younger GPs compared to more senior GPs. Keywords: Communication Channels, Pharmaceutical Industry, Perceptions Of General Practitioners, Lithuania. Evidence suggests that pharmaceutical companies invest one-third of all sales revenues on drug promotion Pharmaceutical companies have faced positive and (World Health Organization, 2015). In most cases, those negative changes in the industry over the last few years. promotion expenses are much higher than R&D new drug For instance, a report by Price Waterhouse Coopers (2007) development expenses (Anderson, 2014). Furthermore, states that demographic, epidemiological and economic complex legal requirements in European countries and factors contribute to the changes in the pharmaceutical fierce competition in the pharmaceutical market of market: the world's population increases (it is expected prescription drugs raises expectations not only to comply that the population will increase up to 7,6. billion by 2020), with those regulations but also search for the most the age of the population increases (by 2020, about 719,4 effective promotion channels to disseminate information million of people, or 9,4 % of the world's population will about newest drugs available on the market. Factors such be 65 years of age and older compared to the 7,3 % of the as the application of national laws, product life cycle, population of the same age in 2005). Traditionally, older patent expiry date, national level of economy and regional people consume more drugs than younger. According to disparities within a country might affect companies' the Health Department in the United Kingdom, four out of decisions about the most suitable communication channels five people over the age of 75 years consume at least one to reach their target groups. prescribed drug and 36 % of those people use four or more Healthcare professionals (or General Practitioners) are prescribed drugs (UK Department of Health, 2001). the major targets of pharmaceutical companies (Schulz et Although the above changes contribute to the development al., 2014; Scott et al., 2013) because of two reasons: (a) of the pharmaceutical industry positively, other factors, physicians are the key decision-makers in selecting such as drug patent expiry time, decreasing portfolio of specific drugs for their patients' prescriptions (Gonul et al., new products, tighter promotion policy regulations of 2001); (b) companies are banned by law from advertising generic drugs (Businessvibes, 2012), increasing influence their prescription drugs directly-to-consumers (with the of health authorities on requesting more informed exception of US and New Zealand). The most common decisions affects drug selection by GPs, shorter lists of communication channel to access GPs and inform them new prescription drugs, stricter laws banning or limiting about new drugs from pharmaceutical companies would be pharmaceutical sales representatives' access to healthcare through sales representatives (personal selling). The literature devotes considerable attention to the pharmaceutical industry. concept of communication channels, specifically, personal selling, which has been popular in promoting new and Vilte Auruskeviciene, Jovita Butkeviciene, Laura Salciuviene. Revisiting the Role of Traditional, Electronic and Mobile existing drugs in the market in the pharmaceutical industry. would discuss several types of drugs, provide additional With constant advancements in the technological scientific information about new drugs, link a GP's environment, more innovative versions of traditional experience with medical products available on the market communication channels become available to the industry and supply materials about diagnostic and treatment thus diminishing the significance and popularity of options. It is not unusual for sales representative to invite personal selling. In addition, other reasons are considered by some sources emphasising a decreasing effectiveness of pharmaceutical companies or local scientific societies. pharmaceutical sales representatives in drug promotion Although visits by pharmaceutical sales representatives (PWC, 2009). Increasing numbers of pharmaceutical sales have been considered one of the most influential representatives, decreasing average representative age and communication channels (Scott et al., 2013), it remains productivity have contributed to this negative trend unclear what perceptions GPs hold about other communication channels used to disseminate medical pharmaceutical sales representatives has also been affected information in terms of their reliability, usage frequency by a limited amount of time they are permitted to spend and value perceptions of those channels. This is especially with a GP during their visit. An average visit lasts less than so in light of emerging electronic and mobile-based two minutes and only 43 % of visits can be considered communications, which have challenged the significance "face2face" (Mack, 2005). of in-person representation in the pharmaceutical industry Although electronic and mobile-based communication (Rod & Sounders, 2009). channels are becoming increasingly popular among companies, there is little research that would consider a Alternative Communication Channels in the holistic approach to prescription drug promotion, which Pharmaceutical Industry communication channels and would investigate GPs' communication channels to access medical information, a perceptions of this approach. Therefore, this research aims traditional doctor-representative conversation might not be to revisit the traditional in-person sales model most longer considered the most effective and the only one commonly used by pharmaceutical companies to date and channel available on the market for information exchange establish GPs' perceptions of traditional and alternative (Ketis & Kersnik, 2013; Rod & Sounders, 2009). For electronic & mobile-based channels in the context of an instance, websites have become irreplaceable for Eastern European country. Our findings contribute to the information search by GPs (Kim & King, 2009; Kim, initial insights into GPs' perceptions of both traditional and 2011; Purcell et al., 2002), they facilitate much quicker alternative (electronic and mobile-based) communication and more convenient access to medical information and are channels in the pharmaceutical industry of Lithuania and perceived as reliable sources of information (Mack, 2005) advise pharmaceutical companies to combine relevant that positively affect product choices (Castronovo & communication channels in the most effective ways to reach their target groups in the prescription drug market. communication channels have become popular tools for Theoretical Background
contacting customers. Channels, such as E-detailing and websites have been used increasingly by pharmaceutical Traditional Communication Channel in the companies (Qanadilo & Chol, 2011). The researchers Pharmaceutical Industry: Personal Selling suggest that perceived value among GPs of information received by e-mails is increasing, for instance, Literature discusses various communication channels communication of medical information by e-email used in the pharmaceutical industry for drug promotion communication channels (Reast et al., 2001). conferences organized by pharmaceutical companies, websites dedicated to healthcare professionals, medical Internet-Based Communication Channels information sent to GPs by e-mail or SMS). The Internet is considered as a relatively new There is an ongoing debate in the literature regarding promotion tool in the pharmaceutical industry. This the role and prominence of personal selling in drug communication channel has become a very popular source promotion. One group of researchers consider in-person selling to be important (e.g., Pedan & Wu, 2011), with pharmaceutical companies have their own websites where positive effects on product promotion (Cavusgil & they provide health and drug-related information, advertise Calantone, 2011). Most GPs agree that personal meetings events organised by companies, but some of those with pharmaceutical representatives are informative companies choose to target only health specialists and limit (Chimonas et al., 2007) and serve as a necessary source of access to their websites to those target customers (David, information (Jones et al., 2001). Typically, representatives are considered to be Pharmaceutical companies have started investing in the knowledgeable in presenting the newest information about development of websites, portals and e-detailing (Qanadilo complex drugs and predicting future trends in the & Choi, 2012) to disseminate the newest medical pharmaceutical industry; they tend to understand needs of information to GPs. However, information on websites has GPs and their patients very well (Hutt & Speh, 2007). one major drawback, such as information security online: When meeting GPs, pharmaceutical sales representatives Inzinerine Ekonomika-Engineering Economics, 2015, 26(5), 541–550 information dedicated to GPs cannot be accessed by their about the benefits of the latest drugs on the market patients in countries where laws prohibit advertising (Janakiraman et al., 2008). Companies start promoting prescription drugs directly to consumers. Also, discussion their new drugs to opinion leaders a year before the drug is forums raise information security issues concerning the introduced into the market (Stros et al., 2009) and use information provided by fellow patients about drugs in opinion leaders to promote the drug in the introductory experience sharing activities online. product life cycle stage (Groves et al., 2002) as well as in the maturity product life cycle stages (Nair et al., 2010). Academic Journals as Communication Channels Positive feedback from innovators and early adopters Findings from previous research on the influence of about new drugs in the market could also play an important alternative channels, such as academic journals and their role in drug promotion, but the frequency of introducing effects on GPs' prescription intentions, are contradictory innovations into the market needs to be considered. (Reast et al., 2011; Vancelik et al., 2009). Although some Although the pharmaceutical industry is well known for studies report this channel being perceived as a reliable and introducing new products into the market frequently, there informative source of information among GPs (Stross et are not many innovators-volunteers willing to try al., 2009), others suggest that more often information by e- innovative drugs. Innovators are well aware of possible mail is preferred to academic journals (Reast et al., 2011). benefits of new drugs, but they also have to be willing to Based on those varying findings reported in previous take risks associated with possible negative side effects. studies we conclude that a variety of reasons might have Early adopters are among the first ones to adopt new affected inconsistencies of preferences among GPs: limited products and some of them might become opinion leaders time available for information search, analysis and who are able to influence others (Perreault & McCarthy, interpretation; limited availability of free academic sources as majority of articles have to be purchased or an annual Research Questions membership is required and access is granted to members only; existing language barrier preventing GPs from Based on the above literature review on both traditional reading the most recent scientific publications in foreign and alternative communication channels, this study raises the following research questions: Scientific Conferences As Communication Channels RQ1: How does the newest medical information reach A communication channel, namely, scientific commu- nities and conferences organised by pharmaceutical RQ2: How do GPs perceive both traditional and companies also receives some attention in the literature on alternative communication channels used to disseminate its importance in disseminating information to GPs and its medical information? influence on GPs' drug prescribing intentions, but with This study aims to provide answers to these questions. conflicting results. For instance, (Burashnikova et al., 2008) suggest that practicing medical doctors are not very interested in attending conferences. Their finding supports Research Design
(Prosser et al., 2003) study indicating that only a small Choice of the Country percent of respondents are interested in conferences as a communication channel. Other research points out more There are specific laws regulating promotional positive outcomes of this channel (e.g., Pitt & Neil, 1998), activities of sales representatives in different countries. For such as high perceived value, high reliability and level of instance, in some European countries (e.g., Slovakia, detail that conferences can offer (Mack, 2005). Reast et al., Hungary) pharmaceutical sales representatives' visits are 2011) investigated the importance of four communication strictly prohibited. In Lithuania, by law, duration of sales channels where conferences & events organised by representatives' visits to GPs is limited: the law prohibits pharmaceutical companies received highest scores on representatives' visits during GPs' surgery hours, while value perceptions in an international context. McGettigan, meetings outside working hours are permitted. As there is Golden et al., 2001) evaluated the impact of events on different product life cycle stages. Their findings suggest that nearly half of the respondents agreed with positive representatives in Lithuania, this country is deemed to be a effects on increasing GPs' intentions to select new drugs; suitable research context to achieve the aim of our study. about one fifth of GPs considered this channel to be significant in increasing their intentions to select drugs Pharmaceutical Industry from a mature product life cycle stage. The pharmaceutical industry is rather complex and Opinion leaders as communication channels controversial in today's world. According to (Levy, 1994), it is R&D and Information Service market. On one hand, In the pharmaceutical industry, opinion leaders are also the main aim of the industry is to increase the quality of used as an effective communication channel for drug people's life and supply pharmaceutics that many people promotion. They would have an extensive experience in require in both developed and developing parts of the clinical research, publish articles in international and world. On the other hand, the industry aims to earn profits national journals (Flicker, 2012), they would be well and therefore has to address some ethical issues in their respected by their busy colleagues willing to listen to them Vilte Auruskeviciene, Jovita Butkeviciene, Laura Salciuviene. Revisiting the Role of Traditional, Electronic and Mobile within 7–10 years (Jaakkola & Renko, 2007; Cavusgil & characteristics that differentiate it from other industries. Calantone, 2011). Those are discussed below in greater depth. After the patent expiry date, generic alternatives The pharmaceutical industry is one of the most (International Non-proprietary Names [INN]) (i.e., intensively R&D oriented industries where an innovation substitutes of the same molecule) become available on the process is the key competitive advantage. R&D investment market (WHO, 2012). Usually, substitutes are possible in this industry is among the highest in comparison to other only for the same therapeutic group (Folland et al., 2004). R&D oriented industries (Levy, 1994). New drug Several important reasons need to be considered for development is characterised as very uncertain and generic medicines to increase their market share. extremely risky: only one in 60 000 synthesised molecules Some reasons refer to expiring patents for many can be evaluated as "very successful" (Jaakkola & Renko, original drugs or a policy of the public authorities. By 2007), only one in 5000–10 000 molecules can be issuing regulations supporting penetration of generic drugs, approved for further drug development and only three in public authorities aim to reduce the prescription drug five new products would become profitable (Folland, budget. Therefore, those regulations (or in some cases- laws) significantly worsen selling conditions for original communication channels to promote drugs is crucial to drugs. Not every manufacturer of original drugs can meet ensure higher returns on investment. new requirements issued by public authorities and might The pharmaceutical industry is one of the most decide to withdraw from the market or target direct-to- regulated and controlled industries (Folland et al., 2004). consumer (pharmaceutics sold over-the counter) drug According to Castagnoli (2008), „the pharmaceutical industry's character – its products, messages, promo channels and even its audiences – have been determined by Budget Decisions in New Drug Promotion governmental regulation and trade conventions" Marketing communication is an essential part Many governmental and public authorities (e.g., Food connecting the results of research, innovation and and Drug Administration in the USA, European Medicines consumers. The effectiveness of different communication Agency in Europe, National Drug Control Agency under channels used to promote new and mature drugs differs The Health Ministry of Lithuania) regulate activities of the (McGettigan et al., 2001), but the industry benefits from a pharmaceutical industry and communcation channels they variety of communication channels available to companies use to promote drugs to consumers. In Lithuania, „The to reach their target audiences (DeLaat et al., 2002). Pharmaceutical Marketing Code" was introduced following In the early stages of the patented product life cycle an agreement among representatives of the Association of only competing products (different molecules) of the same Ethical Pharmaceutical Companies, the Association of Drug therapeutic group can be considered as substitutes. Manufacturers and the Association of the Pharmaceutical Promotional budget allocation depends on the product life Industry. The aim of this document is to guarantee cycle. According to (DeLaat et al., 2002), the peak of the responsible, ethical and professional drug promotion to promotional investment is recorded in the second year of health care professionals. The document contains not only the product life cycle, while about half of that amount is principles of ethical marketing but also consequences of granted for the following 4–7 years. Later, investment for ignoring the law of ethical drug promotion. promotion is consistently falling and after 15 years no Most ethical pharmaceutical companies adhere to strict more than 20 % of the initial budget is invested into internal regulations for drug promotion. Those rules are promoting the product. Interestingly, after the patent expiry often more stringent than the „Marketing Code". Internal date (when generics enter the market) investments in regulations govern the company‘s activities, such as promoting the original drugs still remain high. compliance with legal and regulatory requirements of the Previously presented investment distribution by years Republic of Lithuania and Code of Ethics in the suggests that promotion is used not only to gain but also to pharmaceutical industry. They also define the following: sustain market share by maximising the protection from the company will not perform surreptitious promotion; generic substitutes. promotional messages will be clear, accurate, coordinated, Prescription Drug Market scientifically valid assessments of data. The study focuses on prescription drug market, which Control Mechanisms in the Pharmaceutical is rather different from other drug markets. Prescription drug market can be characterised by high competition, strict laws regulating advertising and personal selling One of the pharmaceutical industry control mechanisms approaches, inelastic pricing and information asymmetry refers to a patent system as every new drug is registered (Castagnoli, 2008; Cavusgil & Calantone, 2011; DeLaat et under a separate patent that expires in 20 years (Harms et al., 2002; Levy, 1994; Pantelic, 2009; Rod & Saunders, al., 2002). Usually, patent is issued after the new molecule 2009). Also, the final decision about the prescription drugs has been registered, but the process of converting a is always made by GPs because they write prescriptions to molecule into a drug, which can be introduced into the their patients. In contrast to many other markets, in the market takes about ten (Jaakkola & Renko, 2007) or even prescription drug market patients do not make the final decision about which prescription drug they should use pharmaceutical companies aim to cover their R&D costs (David, 2001; Folland et al., 2004; Jaakkola & Renko, Inzinerine Ekonomika-Engineering Economics, 2015, 26(5), 541–550 2007; Kim & King, 2009; Kumar & Shafali, 2010; Ladeira in collecting data for the study, a survey was deemed the et al., 2011). most suitable data collection method for this research. Contrary to other countries, where direct-to-consumer Survey data collection method has several advantages: advertising of prescription drugs can be combined with (a) distribution and collection of questionnaires can be industry-to-healthcare (directly to GPs) advertising (e.g., in managed by assistants of a principal investigator; (b) any USA and New Zealand), combined promotion activities for questions raised by respondents about the empirical study prescription drugs are prohibited by law in Lithuania. In can be answered instantly by a person distributing a this country, only healthcare professionals (in our research questionnaire; (c) longer questionnaires can be used (a – GPs) can receive information about prescription drugs number of questions in a questionnaire does not reduce available on the market. They are expected to pass that respondent numbers); (d) a direct contact with assistant information on to their patients and to inform them about ensures high response rates: 70–80 %. The major drawback benefits and drawbacks of those drugs. Furthermore, as 97 of this data collection method refers to high costs required % of prescription drugs are covered by the Health Ministry to hire assistants to distribute and collect questionnaires of Lithuania (Lithuanian PharmaZoom Data, 2012), (Aaker et al., 2012). Lithuanian prescription drug market was selected to investigate GPs perceptions of communication channels Data analysis technique used to communicate information about both new and Data was analysed using SPSS 14. Means () , standard existing prescription drugs available on the market in this deviations (SD) and Mann-Whitney U test was utilised to calculate the findings. Results and Discussion
The total population for this study consists of 4691 registered GPs in Lithuania (Lithuanian Department of Results of the study suggest that the most commonly Statistics, 2012). In total, 290 GPs were approached in surgeries or at various events organised for health pharmaceutical sales representatives and conferences practitioners and personally invited to take part in the organised by pharmaceutical companies to reach GPs with survey. A total of 254 usable responses were obtained medical information. Besides those two channels, the following the questionnaire screening process, which results suggest alternative channels that GPs consider as found three invalid questionnaires (89 % response rate). being reliable, having high perceived value and The data were collected in big cities and small towns of drug-prescribing Lithuania: Vilnius (38 responses), Klaipeda (33 responses), intentions. The main findings of the study are discussed Kaunas (77 responses), Siauliai (32 responses), Panevezys below to provide an answer to each research question. (12 responses), other towns (62 responses). The average age of respondents was 51, 5 (±9,74) years. How does the newest medical information reach To address the first research question (RQ1: how does The survey instrument was designed according to the newest medical information reach GPs?), channel (Churchill & Iacobucci, 2005) recommendations. The usage frequency and channel reliability are discussed. instrument comprises three parts: (a) introduction, (b) main Significant links between channel usage frequency, body of the questionnaire, and (c) demographics. reliability and channels' contribution to increasing GPs' Questions for the main part were derived from the drug-prescribing intentions are identified. literature. A 7-point Likert scale was used to gauge Evidence suggests that pharmaceutical representatives respondent perceptions (1=least important; 7=most (  =6,0±1,262), conferences organised by pharmaceutical important). A list of 17 communication channels that are companies in Lithuania (  =5,48±1,466) and conference used by pharmaceutical companies (e.g., pharmaceutical representatives, healthcare institutions (  =5,30±1,580) are most often used healthcare professionals, medical information sent by e- to provide the newest medical information to GPs in mail or SMS) was prepared. Those channels were selected Lithuania. This finding corresponds to earlier results from the literature and other information sources dedicated reported in the literature (Handa et al., 2013; Prosser et al., to healthcare practitioners. The survey instrument was 2003; Jones et al., 2001) suggesting that pharmaceutical pretested with seven respondents who were asked to fill in representatives remain a popular means to interact with the questionnaire before administering the main study. their target audience, while alternative (i.e., electronic and mobile-based) communication channels, such as sending Data Collection Method (  =2,70±1,826) or SMS After a careful assessment of elements suggested by (  =1,69±1,322), are used less frequently (Table 1). (Aaker et al., 2012) to be considered before making the final decision about the most suitable data collection method to answer research questions raised in this study, such as sampling, type of population, form and content of questions, an expected response rate and the costs involved Vilte Auruskeviciene, Jovita Butkeviciene, Laura Salciuviene. Revisiting the Role of Traditional, Electronic and Mobile Channel usage frequency
Channel importance in increasing drug prescribing
intentions among GPs
Pharmaceutical representatives Conferences organised by Opinion leaders – the leading pharmaceutical companies in experts in the healthcare industry Articles published in local health Conference presentations by pharmaceutical representatives in Conferences organised by local healthcare institutions scientific societies Medical information received by e- Phone calls from pharmaceutical Phone calls from pharmaceutical Sending information by SMS SMS from pharmaceutical Conferences organised by local (  =5,78±1,290) and international (  =5,67±1,311) scientific societies as well as Further, our study identified a statistically significant leading experts in the field (  =5,67±1,456) are considered relationship between the channel frequency and the to be the most reliable communication channels (Table 2). perceived reliability of that channel (p=0,001). Also, This finding is in line with previous studies (Handa et al., empirical evidence suggests a statistically significant 2013; Flicker, 2012). relationship between the channel reliability and the contribution of a particular communication channel to increasing GPs' drug-prescribing intentions (p=0,001). Channel reliability
How Do GPs Perceive Both Traditional And Alternative Communication Channels? Conferences organised by local scientific societies To address the second research question (RQ2: How do Leading experts in the field Conferences organised by communication channels used to disseminate medical international scientific societies information?), perceived value of alternative (i.e., electronic and mobile-based) communication channels was Medical information received by e- evaluated and differences among GPs' perceptions by age Phone calls from pharmaceutical groups were reported. Our study suggests unexpected results regarding SMS from pharmaceutical perceived value of alternative (i.e., electronic and mobile- based) communication channels among GPs. Locally designed websites for medical professionals have the On one hand, communication channels such as opinion highest perceived value (  =4,66±1,589), while the leaders – the leading experts in the healthcare industry – perceived value of information received by e-mail have the strongest contribution to increasing GPs' drug- (  =3,14±1,907) or SMS (  =1,97±1,457) is rather low prescribing intentions (  =5,06±1,707), followed by (Table 4). These findings could not be compared with articles published in local health journals (  =4,92±1,707) earlier research as we were unable to identify any previous and conferences organised by local scientific societies studies on any reported value perceptions by GPs about (  =4,83±1,704). The significance of pharmaceutical communication channels. representatives' contribution on increased intentions is placed 6th. Some of our results are in line with findings reported in earlier research as opinion leaders are very GP's value perceptions of alternative (i.e., electronic and influential when introducing a new drug to the market mobile-based) communication channels (Groves et al, 2002). According to (Flicker, 2012), GPs tend to listen to opinion leaders rather than seek information elsewhere. Locally designed websites for medical On the other hand, communication channels, such as medical information received by e-mail (  =2,48±1,575), Phone calls from pharmaceutical sales (  =2,09±1,488) or SMS (  =1,70±1,279) have limited contribution to increase GPs' drug-prescribing intentions. These findings could not be compared to previous Statistically significant differences among GPs were research, as we could not identify any available articles found regarding both channel preference and perceived reporting similar/different findings (Table 3). reliability of those communication channels by age group. Inzinerine Ekonomika-Engineering Economics, 2015, 26(5), 541–550 Younger GPs (27–43 age group) are more likely to participate at international scientific conferences than the recommended, as the perceived value of these channels is second (44–59 age group) (p = 0,002) or third group (60- relatively small. 75 age group) of GPs (p = 0,003). Younger GPs (27–43 Interestingly, GPs' perceptions differ according to their age group) are more likely to read articles published in age. For instance, younger GPs consider international international health journals (p = 0,049) and use conferences, international publications and international international websites dedicated to health practitioners websites to be more reliable medical information sources more often (p=0,001) than their most senior colleagues compared to more senior GPs. Although pharmaceutical (60–75 age group). sales-representatives' visits to GPs do not appear to be the With regard to perceived reliability of communication most important communication channel overall, they channels, international conferences are considered more remain preferred by most senior GPs. Therefore, reliable by younger GPs (27–43 age group) compared to pharmaceutical companies should take into consideration senior GPs (44–59 age group) (p=0.01). Younger GPs (27– the age of GPs when evaluating the effectiveness of 43 age group) also perceive international scientific traditional and alternative (i.e., electronic ad mobile-based) publications as more reliable compared to most senior communication channels to reach their target audiences colleagues (60–75 age group) (p=0,02). The most senior with medical information. group of GPs (60–75 age group) trust information acquired through visits and presentations by pharmaceutical sales Limitations and Future Research Directions
representatives (p<0,001) and at local conferences organized by pharmaceutical companies (p=0,01). As with any other research, this study has limitations that indicate future research directions. Conclusion and Practical Implications
First, our study did not use a probability sample. Probability sampling would involve a larger sample of GPs The aim of this study was to revisit traditional and and allow generalisation of results on perceptions of both traditional and alternative (i.e., electronic and mobile- communication channels most commonly used in the based) communication channels among GPs in Lithuania. Second, our findings suggest statistically significant information and investigate GPs' perceptions of those differences among GP groups by age regarding choice and channels in the drug prescription market of Lithuania. reliability of communication channels. However, we did The results suggest that pharmaceutical sales not aim to identify any reasons as to why those differences between younger and more senior GPs occur. Thus, further pharmaceutical companies are the most common channels studies could aim to investigate the role of specific reasons used to disseminate the newest information to GPs. (e.g., a language barrier, limited time to access information While those channels play an important role in reaching online or to visit a conference event) in channel GPs, our findings also reveal that leading experts in the preferences among GPs. field contribute significantly to increasing GPs' intentions Next, our study did not examine features of alternative to prescribe specific drugs to their patients, followed by local conferences and publications in Lithuanian language. channels available to GPs, but future studies could deepen International, local scientific conferences and leading our understanding of the role of interactive websites (e.g., experts in the field are also considered to be the most social presence on a website) when accessing medical reliable ones among GPs. information online to increase GPs' involvement with the With regard to perceived value of alternative (i.e., electronic and mobile-based) communication channels by Further, our indicative data analysis suggests GPs, only local websites designed for healthcare statistically significant relationships between channel professionals received the highest evaluations from GPs. usage frequency, perceived reliability and its importance in In order to gain maximum benefits and efficiently increasing drug-prescribing intentions among GPs. disseminate information about prescription drugs, these Gaining more knowledge on the relationship of reliability- channels can be combined effectively with each other, for drug-prescribing intentions would allow pharmaceutical example, by investing in satellite communications to allow companies to better understand causality of those concepts opinion leaders to present their ideas at both local and along with potential ethical issues that the usage of some international scientific conferences. Another group of communication channels may raise about GPs' priorities for specific prescription drugs (Makowska, 2014; Poulsen successfully are conferences sponsored by pharmaceutical et al., 2013, Sah & Fugh-Berman, 2013, Spurlig et al., companies or co-organised with scientific bodies to publish proceedings with conference papers presented that could be made freely available online. Given that websites designed for healthcare professionals have the highest perceived value among GPs, pharmaceutical companies might consider allocating more resources towards the development and maintenance of this popular online communication channel in Lithuania. Based on the findings, considerable reduction in the preparation and Vilte Auruskeviciene, Jovita Butkeviciene, Laura Salciuviene. Revisiting the Role of Traditional, Electronic and Mobile References

Aaker, D. Kumar, V., Leone, R., & Day, G. (2012). Marketing research, New York, Willey. Anderson, R. (2014). Pharmaceutical Industry Gets High on Fat Profit. BBC News. Available from internet: Burashnikova, I. S., Ziganshin, A. U., & Ziganshina, L. E. (2008). Attitudes to Pharmaceutical Promotion Techniques among Healthcare Professionals in the Republic of Tatarstan, Russia. International Journal of Risk & Safety in Medicine, 20, 57–71. Businessvibes. (2012). Pharmaceuticals Industry – fact sheet. Castagnoli, W. (2008). A Split on DTC is Coming. Medical Marketing and Media, May2008, 43(5), 82p. Castronovo, C., & Huang, L. (2012). Social Media in an Alternative Marketing Communication Model. Journal of Marketing Development and Competitiveness, 6(1), 117–131. Cavusgil, E., & Calantone, R. (2011). Are Pharmaceutical Marketing Decisions Calibrated to Communications Effects? Health Marketing Quarterly, 28, 317–336.
Chimonas, S., Brennan, T. A., & Rothman, D. J. (2007). Physicians and Drug Representatives: Exploring the Dynamics of the Relationship. Journal of General Internal Medicine, 22, 184– Churchill, Jr. G. A., & Iacobucci, D. (2005). Marketing research: Methodological foundations (9th ed). Mason, Ohio: Thomson South-Western. David, C. (2001). Marketing to the Consumer: Perspectives from Pharmaceutical Industry. Marketing Health Services, De Laat, E., Windmeijer, F., & Douven, R. (2002). How Does Pharmaceutical Marketing Influence Doctors' Prescribing Behaviour? CPB Netherlands' Bureau for Economic Policy Analysis, The Hague, the Netherlands. Fischer, M. A., Keough, M. E., Baril, J. L., Saccoccio, L., Mazor, K. M., Ladd, E., Von Worley, A., & Gurwitz, J. H. (2009). Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting? Journal of General Internal Medicine, 24(7), 795–801.
Fisher, M., & Albers, S. (2010). Patient- or Physician-Oriented Marketing: What Drives Primary Demand for Prescription Drugs?. Journal of Marketing Research, 47(1), 103–121. Flicker, L. (2012). The Influence of Opinion Leaders. Australian Prescriber, 35(3), 74–5. Folland, S., Goodman, A. C., & Stano, M. (2004). The economics of health and health care (4th ed.). Upper Saddle River, N.J: Prentice Hall. Gonul, F., Carter, F., Petrova, E., & Srinivasan, K. (2001). Promotion of Prescription Drugs and its Impact on Physicians' Choice Behaviour. Journal of Marketing, 65(3), 79–90. Groves, K. E. M., Flanagan, P. S., & MacKinnon, N. J. (2002). Why Physicians Start or Stop Prescribing a Drug: Literature Review and Formulary Implications. Formulary, 37(4), 186–194. Handa, M., Vohra, A., & Srivastava, V. (2013). Perception of Physicians towards Pharmaceutical Promotion in India. Journal of Medical Marketing, 13(2), 82–92.
Harms F., Rohmann S., Heinrich M., Druener M., & Trommsdorff V. (2002). Innovative Marketing. Pharmaceuticals Policy and Law, 5, 135–149. Jaakkola, E. & Renko, M. (2007). Critical Innovation Characteristics Influencing the Acceptability of a New Pharmaceutical Product Format. Journal of Marketing Management, 23(3–4), 327–346.
Janakiraman, R., Dutta, S., Sismeiro C., & Stern P. (2008). Physicians' Persistence and Its Implications for Their Response to Promotion of Prescription Drugs, 54 (6), 1080–1093. Jones, M., Greenfield, S., & Bradley, C. (2001). Prescribing New Drugs: Qualitative Study of Influences on Consultants and General Practitioners, British Medical Journal, 323(7309), 1–7.
Ketis, Z., & Kersnik, J. (2013). The Assessment of Pharmaceutical Sales Representatives by Family Physicians—Does it Affect the Prescribing Index? Family Practice, 30(3), 320-324.
Kim, H. (2011). Pharmaceutical Companies as a Source of Health Information: A Pilot Study of the Effects of Source, Web Site Interactivity, and Involvement, Health Marketing Quarterly, 28(1), 57–85. Kim, W. J., & King, W. K. (2009). Product Category Effects on External Search for Prescription and Nonprescription Drugs, Journal of Advertising, 38(1), 5– Inzinerine Ekonomika-Engineering Economics, 2015, 26(5), 541–550 Kumar, A., & Shafali. (2010). E-strategy for Pharmacy Marketing in Information Age. The Pharma Research, 4(1), 149– Ladeira, W. J., Dalmoro, M., Maehler, A. E., & Araujo, C. F. (2011). Drug Prescription Practices in Brazil: a Structural Equation Model. International Journal of Pharmaceutical and Healthcare Marketing, 5(4), 262– 278. Lenskold, J. (2005). Finding The „Right Stuff" to Revitalize Sales Productivity. Pharma Marketing News Supplement. Levy, R. (1994). The Role and Value of Pharmaceutical Marketing, Archives of Family Medicine, 3(4), 327–332. Lithuanian Department of Statistics (2012). Available from intern Lithuanian PharmaZoom Data (2012). Available from intern Mack, J. (2005). Intelligent Online Sampling Strategies. Pharma Marketing News Supplement. Accessed on 01 October Makowska, M. (2014). Interactions between Doctors and Pharmaceutical Sales Representatives in a Former Communist Country. Cambridge Quarterly of Healthcare Ethics, 23(3), 349–355.
McGettigan, P., Golden, J., Fryer, J., Chan, R., & Feely, J. (2001). Prescribers Prefer People: The Sources of Information used by Doctors for Prescribing Suggest that the Medium is More Important than the Message. British Journal of Clinical Pharmacology, 51, 184–189 Nair, H., S., Manchanda, P., & Bhatia T. (2010). Asymmetric Social Interactions in Physician Prescription Behavior: The Role of Opinion Leaders. Journal of Marketing Research, 47 (5), 883–895 Pantelic, D. (2009). Internet as a Medium of Pharmaceutical Companies Promotional Activities. Management Information Systems, 4(1), 29–37. Pedan, A., & Wu, H. (2011). Asymmetric Responsiveness of Physician Prescription Behavior to Drug Promotion of Competitive Brands Within an Established Therapeutic Drug Class. Health Marketing Quarterly, 28, 133–154. Pitt, L., & Nel, D. (1998). Pharmaceutical Promotion Tools — Their Relative Importance. European Journal of Marketing, 22(5), 7–14.
Poulsen, K., Glintborg, D., Moreno, S., Thirstrup, S., Aagard, L. & Andersen, S. (2013). Danish Physicians' Preferences for Prescribing Escitalopram over Citalopram and Sertraline to Treatment-Naïve Patients: a National, Register-Based Study. European Journal of Clinical Pharmacology, 69(13), 1167–1 PriceWaterhouseCoopers (2007). Pharma 2020: The vision. Which path will you take? PriceWaterhouseCoopers (2009). Pharma 2020: Marketing the future. Which path will you take? Prosser, H., Almond, S., & Walley, T. (2003). Influences on GP's Decision to Prescribe New Drugs – the Importance of Who Says What, Family Practice, 20(1), 61–68.
Purcell, G. P., Wilson, P., & Delamothe, T. (2002). The Quality of Health Information on the Internet, British Medical Journal, 324, 557–558.
Qanadilo, H., & Choi, K. (2012). The Personal Touch in Digital Promotion, Pharmaceutical Executive, 32(5), 96–97. Reast, J. D., Lindgreen, A., Palihawadana, D., Spickett-Jones, G., & Barnes B. R. (2011). Prescription Drug Communication Strategies: A Comparative Analysis of Physician Attitudes in Europe, the Middle East, and the Far East, Journal of Marketing Management, 27(3/4), 336–360.
Rod, M. & Saunders, S. (2009). The Informative and Persuasive Components of Pharmaceutical Promotion, International Journal of Advertising, 28(2), 313–349.
Sah, S., & Fugh-Berman, A. (2013). Physicians under the Influence: Social Psychology and Industry Marketing Strategies. the Journal of Law, Medicine and Ethics, 41, 665–672.
Schulz, S., Broekemier, G., & Burkink, T. (2014). Attitudes and Beliefs Regarding Direct-to-Consumer Advertising of Pharmaceutical Drugs: An Exploratory Comparison of Physicians and Pharmaceutical Sales Representatives. Health Marketing Quarterly, 31(3), 279–291.
Scott, P., McIntosh-Scott, A., & Stokes, P. (2013). Sales and Strategic Marketing Practices in the Pharmaceutical Industry: Doctors as Customers and their Decisions. Journal of International Business and Entrepreneurship Development, 7(1), 37–51.
Vilte Auruskeviciene, Jovita Butkeviciene, Laura Salciuviene. Revisiting the Role of Traditional, Electronic and Mobile Spurling, G. K., Mansfield, P. R., Montgomery, B. D., Lexchin, J., Doust, J., Othman, N., & Vitry, A. I. (2010). Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: a Systematic Review. PLoS Medicine, 7(10), 1–22.
Stros, M., Hari, J., & Marriott, J. (2009). The Relevance of Marketing Activities in the Swiss Prescription Drugs Market. International Journal of Pharmaceutical and Healthcare Marketing, 3(4), 323–346.
UK Department of Health. Medicines and Older People: Implementing medicines-related aspects of the NSF for Older People. (2001).
Vancelik, S., Beyhun, N., Acemoglu, H., & Calikoglu, O. (2007). Impact of Pharmaceutical Promotion on Prescribing Decisions of General Practitioners in Eastern Turkey. BMC Public Health, 7, 122–129.
World Health Organization. (2012). International Nonproprietary Names. World Health Organization (2015). The article has been reviewed. Received in June, 2015; accepted in November, 2015.


Optical training 12082_Healthcall_Training Doc_MASTER.indd 1-2 Promoting eye health and maximising independence for all Code of Practice for Domiciliary Eyecare September 2009 The Domiciliary Eyecare Committee is grateful for the comments of the UK Departments of Health on this Code • NHS eye examinations will be provided on request to those who cannot access


Original Paper Nephron Clin Pract 2012;122:75–79 Received: November 27, 2012 Accepted: February 12, 2013 Published online: M arch 28, 2013 Uraemic Pruritus: Relief of Itching by Gabapentin and Pregabalin Hugh Rayner Jyoti Baharani Steve Smith Vijayan Suresh Indranil Dasgupta Heart of England NHS Foundation Trust, Birmingham , UK