COMSATS Institute of Information Technology, Attock Campus

Form for Approval of Synopsis of Graduate Programs Students

(MS/MBA/Ph.D) of CIIT
Student’s Details;
Registration No:CIIT/SP17-RMS-017/ATK Name: Mubashir Hussain

Father Name: Shaukat Hussain Program Name: RMS

Area of Specialization (If any as per Marketing

approved SOS):

Supervisors’ Details;

1. Supervisor’s Name and Designation:

Dr. Syed Asim Shah (Assistant Professor)

Synopsis Title:
Determinants Effecting Physician’s Medicine Adoption with moderating
effect of role of generic: A Study Of Services Sector

Recommended and Signed by Supervisory Committee (Name & Signature)

2. Dr. Syed Asim Shah ............................................................Supervisor

3. Dr. Saddam Hussain.................................................................Member

4. Dr. M. Shakil Ahmed… ........................................................ Member

5. Dr. Khawaja Fawad Latif.......................................................Member

6. Dr. Faisal Shehzad ............................................................... Member

 1. Summary of the Research Proposal

Pharmaceutical organizations spend a

substantial amount of their budget on marketing and promotional activities to generate
maximum profit. Thus, it becomes very important to study the physicians pattern of
adoption of medicine.. in this study I will explore that to what extent promotion
tools(Pharmaceutical advertisement ,Electronic detailing and round table
discussion)influence prescription behavior as perceived by doctors.in this study I will
explore the role of generic medicine as moderator, as generic drugs plays an important
role in doctor adoption of medicine. I will explore the reason why doctor prefer generic
medicine rather than branded medicine For that Primary data for the study was collected
through a survey of physicians through questionnaire. Questionnaire contain Likert scale
,it has two parts first one is Demographic and second contain the questions relating the
variables. Each variable has a set of item. A total number of 382 physicians will
participate in the
study. .Unit of analysis will be physician from Pakistan two big cities. Study type will be
descriptive and regression analysis will be done to find correlation between variables.

Key words: Direct to Doctor, Direct to Consumer, Round table Discussion, Role of
generic medicine, Doctor adoption of medicine

2. Introduction

Same as other organizations Marketing is the force which drives

the opinion of KOLs in pharmaceutical industry (Lexchin,1992). Same as further
industries, the prime purpose of pharmaceutical advertising and marketing is to increase
and maintain the profitability ratio of that company by fulfilling the needs and wants of
customers and consumers and eventually gaining gratification (Maqsood and Sattar,
2003). What is the specialist prescription pattern and behavior that is the prime
assumption for all the pharmaceutical companies (eWazana,2000). For pharmaceutical
industry physician is the utmost important stakeholders because he is the final decision
maker rather than the patient. The connection between pharmaceutical industry and
physicians is much controversial due to the immersion of personal profits and clash
among money and ethics. According to a many researchers, a good relationship of
physician with medical representatives has a higher impact on the prescription pattern
(Rizwan Raheem Ahmed, 2014). According to (Biswas K and Ferdousy ,2017)
Pharmaceutical advertising and marketing is pretty diverse than regular marketing as the
final verdict makers are doctors which are secondary customers and not by the patients
which are original consumers, therefore tremendous sales and marketing strategies are
intended to focus on the GPs and physicians. The existing literature and studies shows
that doctors and pharmacists are well informative on the impact and use of generic
medications which help to the betterment in globally approached to medications. Yet,
variances exist regarding the considerations of these doctors about the superiority of the
generic drugs depending on the economic condition and growth in health care system of
that country (Toverud 2015).( Nair 2010) concluded that GP’s prescribing habit is
expressively influenced and dominated by the behavior of KOLs in domain of GP’s peer
influenced groups.

2.1 Background of Study

Physicians and pharmaceutical industry has been

considered as the foremost key role players of pharmaceutical industry (Amin, 2012).
The economy of Pakistan is expressively contributed by the pharmaceutical industry
which is increasing at a rapid rate (Zaman, 2011). In Pakistan there are almost 750
registered pharmaceutical manufacturing units in which 400 are producing drugs for
different diseases, including those they include 24 multinationals. The current ratio of
multinational vs national companies in pharmaceutical industry of Pakistan is 2:3;
GSK(Glaxo Smith Kline) is at the top position among multinationals companies while
Getz Pharmaceutical is on top position among nationals with the market shares of
11.60% and3.75% vice versa. (Mehmood, 2016). Almost 80% of the local market need
and demand is fulfilled by the national companies of Pakistan, 90% of active ingredients
and raw material used in the making of medicines are imported from European countries
(Rizwan Raheem Ahmed, 2014). Many of the studies had been carried out to examine the
dominance and influence of promotion tools on the prescribing behavior (adoption of
medicine) of doctor by pharmaceutical companies. However, the results were not always
consistent(Bhatt, 1993; Pavan, 2008). The main goal of this paper is to explore the impact
of pharmaceutical promotional tools and strategies on doctors perception and adoption
of medicine in Pakistan.

In order to achieve that, the following objectives have been fulfilled:

To develop a theoretical framework that outlines the hypotheses relationship between the
pharmaceutical promotion tools and physicians adoption of medicine prescribing in
Pakistan based on the research results and the previous related studies; to investigate the
extent of acceptance of physicians in Pakistan of the pharmaceutical promotion tools; to
assess the impact of pharmaceutical promotional tools on physicians perception and
adoption of medicine prescribing in Pakistan; to identify the most influential
pharmaceutical promotional tools on physicians adoption of medicine prescribing in
Pakistan; and to provide the Pakistani pharmaceutical companies decision makers with
recommendations that might help the marketing units in these companies to increase their
focus on physicians. This paper gives an idea about the effects of DTC (Direct to doctor
advertising), E- detailing ,DTC(Direct to consumer advertising) and webinar or RTDs
have an impact on doctor adoption of medicine. The term ‘generic medicine is used in
diverse forms for example “it can be a medication that is marketed

under the generic name which is not second copy of the brand and work same as brand”
(Jamshed 2009). Generics medicines are the simple copies of previous pharmaceutical
medicines. They are basically sold under a generic name which are called branded name
generics .even generics medicines name are same as their included active ingredient
which is called INN (International Nonproprietary Name ) (Danchev ,Nikolova, 2007).
According to Danchev and Nikolova, 2007 a generic medication is same copy same as a
brand-name medication and it is same in all aspects which include dosage , Bio
availability, side effects, contra indication, efficacy and indicated use. Since generic
medicine are made to use the similar active ingredients and protocols which shown to
work as similar as brand in the patient’s body, even they produce the same side effects
and have same bio-availability as their same molecule containing brand-name medicine
2.2 Gap to be Addressed:

(1) The main study aims to investigate the effect of

pharmaceutical promotional tools which are detailing visit by medical representative,
price of promotional drug, external CMEs and free sampling to doctors. According to that
study most dominant and influential independent variable was price of medication and
after this free sampling and then medical representative visits to doctors and external
CMEs .

in future recommendations Author has recommended that further studies are needed to
investigate the impact of direct to doctor advertisement ,direct to consumer
advertisement ,Round table discussions and medical representative detailing by tablet
and laptop impact on physician adoption of medicine

Alshurideh, M. (2018). Pharmaceutical Promotion Tools Effect on Physician's Adoption

of Medicine Prescribing: Evidence from Jordan. Modern Applied Science, 12(11).

(2) According to this study authors investigated the impact of pharmaceutical digital
marketing tools on health care physician of Pakistan. Author has conclude that impact of
different digital promotional tools which include Facebook , marketing emails, tele
detailing ,WhatsApp and web detailing has different degree of impact on physicians.
Most influential tool was webinar or webcast.

In future recommendation author recommended that digital marketing has a room of

improvement. Author suggested some strategies which are to conduct case studies
,launch the mobile applications focusing on Electronic detailing through which medical
representative keep the physician up to date .

Jawaid, M., & Ahmed, S. J. (2018). Pharmaceutical Digital Marketing and Its Impact on
Healthcare Physicians of Pakistan: A National Survey. Cureus, 10(6).
(3) According to this study author briefly evaluated the impact of pharmaceutical
promotional tools on doctor prescription in Nigeria .Author concluded that it is matter of
great concern That promotional activities may act negatively on prescribing quality and
treatment cost bearded by patient. In future recommendation the author emphasized that
there is more need of studies on pharmaceutical promotion .Through it will help in
reducing lackness in prescribing and the use of sudden medications.

Author also suggested that there is a much studies are also needed to explore the role of
generic medicine prescribing on physician medicine prescription and adoption and it can
be checked in different ways.

Fadare, J. O., Oshikoya, K. A., Ogunleye, O. O., Desalu, O. O., Ferrario, A., Enwere, O.
O., ... & Godman, B. (2018). Drug promotional activities in Nigeria: impact on the
prescribing patterns and practices of medical practitioners and the implications. Hospital
Practice, 46(2), 77-87.

2.3 Problem Statement:

The problem of this study is to explore the impact of

pharmaceutic al promotional tools impact on doctor adoption of medicine in Pakistan
with the moderating effect of role of generic medicine. There is a lot of literature
regarding different aspects of pharmaceutical marketing Based on the previous research,
the following recommendations would help enhance the pharmaceutical companies’
promotional efforts directed to the physicians. According to previous studies the
correlation between the effect of pharmaceutical promotional tools and strategies on
physicians’ perception and adoption of medicine prescribing. in Pakistan was reasonably
and positively high, so pharmaceutical companies in Pakistan are recommended to pay
more attention to these promotional tools in their promotional mix in order to better effect
physicians’ adoption of medicine in their favor.

That is needed to investigate that pharmaceutical advertising and conducting scientific

group meetings and digital distribution has an impact on doctor adoption of medicine and
it is also to investigate that role of generic medicine has moderating effect among direct
to doctor advertisement and doctor adoption of medicine

2.4 Research Questions:

Q1: Does Pharmaceutical Direct to consumer advertising has positive impact on

physicians medicine adoption?

Q2: Does Pharmaceutical Direct to Doctor advertising have positive association with
physicians medicine adoption?

Q3: Does Scientific Group Meetings has significance influence on physicians medicine
adoption?

Q4: Does Digital Distribution have positive association with physicians medicine
adoption?

Q5: Does Role of generic has a moderating effect between direct to doctor
advertisement and physician adoption of medicine?
2.5 Objective of Study:

The most important goal of the research is to explore the factors that
impacts physician’s medicine adoption with the moderating effect of role of generic
medicine between direct to doctor advertisement and doctor adoption of medicine. To
achieve this, the following main objectives will be accomplished:

 To examine positive influence of Pharmaceutical Direct to consumer

advertisement on physicians medicine adoption?
 To investigate the significance of Pharmaceutical Direct to doctor
Advertising on physician adoption of medicine
 To determine the positive association of Digital Marketing on
physicians medicine adoption?
 To review the significance of Scientific Group Meetings on physicians
medicine adoption?
 To assess the moderating effect of role of generic between direct to
doctor advertisement and physician adoption of medicine?
1. Literature Review

Direct to Doctor Advertisement:

Throughout all the history, pharmaceutical

organizations and advertising firms have established an exceptionally and exceedingly
high profitable industry. One of the important primary channels that has been very
effective in creating significant revenues is Direct-to-Physician/Doctor (DTP) advertising
(Pedan & Wu, 2009). It has been recognized that DTP advertising has the ability to effect
even influence physician prescribing behaviors, although physicians can argue otherwise
(Avorn, Chen & Hartley, 1982). However, most of the pharmaceutical industry spends a
immense amount of time and money into discerning the doctors which most frequently
prescribe (Fugh-Berman & Ahari, 2007). Sometime These physicians, referred to as
KOLs(key opinion leaders) or high decile prescribers, they are mainly targeted for
promotional purposes and strategies as they provide an immense Return on Investment
(ROI) that affects very positively on pharmaceutical bottom Line(MRs), both of which
proposes that advertising does in fact positive influence physician prescribing behaviors
(Fugh-Berman & Ahari, 2007). (McKinney2009)study concluded that doctors behavior
could be altered by accepting different gifts from medical sales representatives.
According to (Freek F, Ward Fi,2108, ) Physician–pharmaceutical industry and its PRs
connections and taking of promotional gifts from the Pharma Sales representative (PSRs)
have been founded to have an effect on GPs’ adoption of medicine and they also
contributed in unneeded and irrational prescription of medicine of the company’s drug.

Direct to Consumer Advertisement:

Direct-to-consumer advertising(DTCA) is very
familiar and not a new statement amongst health communication researchers and
marketers. Thus far, there is a need for a pure definition of DTCA. (Bradley , Zito 1997)
devised the statement(DTCA) as “any promotional effort on tv media by a
pharmaceutical organization to show drug prescription information to the patients which
are end customers include general public in the familiar language. DTCA “Direct-to-
consumer advertising” includes advertising and promotion of over-the-counter(OTC)
medications or only include prescription medications. The widely held studies have
concluded that consumers patients are more likely to talk with medical doctor if they
have information which in result convert positive attitude and perception to direct to
consumer advertising(DTCA) (Herzenstein ,2004)(Singh and Smith, 2005)( Wilson and
Till,2007)( Lee et al., 2007)( Sumpradit et al., 2002).
Additional studies recommended that consumer’s e.g. patients contribution in healthcare
system, contribute the high motivation to seek out and intellectual process to learn
health-oriented information impact their intents of discussing with clinicians (Till and
Wilson , 2007).( Lee 2007) reveals that consumer’s patients trust on interactive channels
for health care info centrals them to involve in more active and interesting deliberations
with their medical doctor. (Khanfar 2009) conclusions indicated that DTCA on
television media for medication prescription can have impact on awareness about
product and enable patient to -initiate the prescription requests. According to (Julie M
and Meredith 2018) concluded that expenses on DTCA direct-to-consumer advertising
has continually raised in topical years even lot of the condemnations arised counter to it.
authors findings propose that ask for a suspension on such promotion and advertising for
new medications would signify a dramatic exit in present practices.

Electronic Detailing:
In the America, approximately wholly pharmaceutical
organizations have originated programs relating e-detailing, to target doctors in specific
rehabilitation areas (Reuters Business Insight Health Care, 2003) . In the viable studies
there are numerous explanations of e-detailing. According to Data monitor literature in
2001/2002 they suggest the subsequent meaning of E-detailing: “the usage of the
tablets, laptops as the source of communication for pharmaceutical medical sales
representatives detailing of doctors”(Wilke, 2001).
Forrester Research group (2005) suggested an alternate meaning for E-detailing: “a
medicinal device e.g. laptop or tablet which are sponsored by firm E-program which
are internet-based that updates doctor(physicians) on knowledge regarding products
,generic or diseases” (Boehm, 2005).
(Bates 2002) concluded e-detailing as use of digital knowledge while in the detailing
procedure, therefore it includes many arrangements which include use of digital
technologies, such as the video-conferencing ,webcast and webinar for allowing the
communication with the medical doctor. literature have also concluded that Pharma
 Sales Representative frequently visits impact requirements to add new medicines to
hospital formularies, which mostly upsurge the cost of prescribing (Chren and
Landefeld, 1994)( Ferguson 1999). On the other hand, numerous literature done by
private firms claimed that electronic-detailing has a robust influence on doctor
prescribing behavior comparing than old-style detailing (McKiline, 2002)(Boehm,
2005) (Gleason, 2000)

Scientific group meeting:

Digital marketing is substituting old-style marketing strategies

in the pharmaceutical industries(jawiadd2018). Innovations which are Internet-based are
one instance of how fast technology advancing in medical system off health and care
and altering the method people are conversate in health information (Tzeng 2008).
Mainly, the internet documents contact to health and care data and services on specific
diseases, behaviors and management in health (HIMSS,,2003); also it lets for the
development of the medical practices cheers to the nonstop monitoring of health
circumstances over some digital tools and strategies to surge the distribution of
information amongst patient and physician, therefore supportive clinical verdict and
disease administration. Still, the appropriate use of data examination tools and technique
in healthcare establishments could influence decision-making efficiency and acquisition
of valued knowledge (Wang,Byrd, 2017). Likewise, Web 2.0 can provide many chances
for health care involvement due to the admission to practice-specific information.
Patients and physicians can have interaction electronic archives, which upsurge exchange
in information, communiqué and association between numerous actors while ornamental
healthcare consequences and dropping prices. Besides, social networking facilities let
users to share info and data inside a organization of players, linking users and medical
doctor to each other. The medical health and care system is communal system concerned
with, accomplishment outside the limitations of organizations, and it may include the way
information is shared amongst doctors, with their patients and other specialist in the
health and care system (Antonacci 2017)( Barsky and Purdon, 2006).
Doctor Adoption of medicine:

Doctors are the most essential key players in the

pharmaceutical industry. Physician plays as essential part of backhanded purchaser for
the patients by diagnosing, choosing a specific therapy segment and recommending the
particular brand of the separate medication(SAXENA,2018). (Patrica Paredes & Manuela
De La Pena 1996) has done research on the determinants influencing the prescribing
behavior in the anti-diarrheal sector was viewed as relevant and incorporated into the
review as their study suggest diagnostic uncertainty as one of the essential constraint
driving the physicians prescribing behavior. (Dieter Scharitzer & Harald C Kollarits
(2000)) has concluded in their research the fundamental relationship between the
satisfaction score from physicians mentioning to the Pharma sales representatives, their
prescribing behavior and the financial accomplishment in six locale of Austria. The
experimental study configuration concluded that the satisfaction scores mainly on image
of the Company and its reputability and its administration in a wide-ranging sense,
quality of products offered, and ability of the pharmaceutical representative to nurture
relationship.

(Melissa A. Fischer (2009) et al) in their research study to know the reasons why

prescribers interact with the Pharmaceutical Representatives (PR) in USA. The PR

communication was seen to be very beneficial for the patient care and overall practice
health. Andree Bates et.al. (2002) has concluded in their research paper the effectiveness
of e-detailing (across numerous drug life cycle stages and for variability of segments of
physicians according to their prescribing habits) and rate of profitability via a case study
approach. Ying Xie (2004) concluded in his study on promotion blend management in the
Prescription Pharma Industry considered Direct to Consumers (DTC) advertisements and
physician advancement in antidepressant category which were generally carried by
utilizing the patient visit data and brand sales data via demand and binary decision
exhibition.
Moderating Variable

Role of Generic Drugs:

While the innovation in form of of generic medicine has not only

aided in decrease of total health and medical care costs, even it also presented a
extraordinary chance to study market progression of pharmaceutical industry products
e.g. medicine (Sanyal,Datta, 2011). The present studies indicated that doctors and
pharmacists are well conscious about the usage of generic medicine for the wellbeing of
worldwide approach to medication. So far, variances exist concerning the deliberations of
these doctors concerning the quality and efficacy of generic medicine reliant on the
maturing of their country medical health care system (Toverud 2015).

Prescription of physicians plays a very important and dynamic role to examine the
doctors choice of a medication in a treatment. Marketers and sales players are gradually
focusing on examination of the prescribing patterns and perception of the

doctors and their prescribing behaviors (Chaganti, 2005). According to (Narendran

Narendranathan (2013) concluded that healthy relationship with the physicians and GPs
launch table discussion symposium meetings, the credibility of the company, high quality
of the generic medicine and credible brand names significantly impact and dominate the
prescribing behavior of doctor,

whereas indirect mailers, advertisements on journal and providing chit pads, letter pads
and other perks are fewer effective. The health care physician and doctors plays a very
vital role to determine whether his patient requirements are a branded medicine or
generic medicine, for a generic alternative may not always be suitable in certain
circumstances where as only a branded medication would be appropriate for the patient
(Bakthavathsalam,2006). GPs have their own approaches to prescribe medications.
Previous literature have confirmed the reputation of normative beliefs in prescriptions
(Segal and Hepler, 1985)( Chinburapa and Larson, 1988)( Perkins 2007). This is related
to what they perceive for example prescribtion of such medications they are known of,
specific brand names and even latest medications (Tootelian 1988)( Probyn, 2004).
(Waheed2011) concluded that diverse gift items to doctors by the pharma companies
donate to continuous generating of prescriptions of medications. They have also
concluded that the professional values of salespeople positively influence GPs
prescription habits. Though, their literature has not support the impact of medical sales
representatives’ personality traits, medicine quality ,efficacy, commercial standing and
professionalism impact on prescribing behavior of physicians. According to (Singh 2008)
highlighted the significance of pharma companies to pulling their existing resources by
implementing new innovation ,strategies in the marketing communiqué procedure and by
getting positive benifits on the positive word-of-mouth/positive publicity positive
references of doctors to improve the learning of the salespeople(MRs) in dominating
physicians. (Phuong Hong Le1, Mai Tran Phuong Nguyen2018) recommended that to
improve the efficacy of generic medication use as well as the quality of local generic
medicines impact on doctor attitude and behavior.
3.2 Framework

Research Theoretical Framework

Independent Moderator Dependent

variables variables variables

Role of Generic
Medicine

H1
Direct To Doctor
Advertisement

H2 Physician Adoption of
Direct to Consumer medicine
Advertisement

H3

Electronic Detailing

H4

Round Table
Discussion

Model Sources:

Alshurideh, M. (2018
3.3 Hypothesis:

H1: The Pharmaceutical Direct to Consumer advertisement has positive effect on

physicians medicine adoption?

H2: The Pharmaceutical direct to doctor has positive association with physician’s
medicine adoption?

H3: The Scientific Group Meetings has significant influence on physician’s medicine
adoption?

H4: The Digital Distribution has positive association with physician’s medicine
adoption?

H5: The role of generic drugs has a moderating effect between direct to doctor
advertisement and physician’s medicine adoption?
Research Methodology
4.1 Research Design:
This study considered a survey tool that was administrated to
collect data about two components of Pharma advertising ,Digital Distribution and
Scientific group meeting impact on physicians’ adoption of medicine prescribing in
Pakistan also descriptive research design will thus make predictions and examine the
impact of direct to doctor advertisement on doctor adoption of medicine with
moderating effect of role of generic drugs.

4.1.1 Type of Study:

Quantitative survey methodology will be taken out to conduct the study.

4.1.2 Unit of Analysis:

The unit of analysis Physician practicing in Pakistan. Survey method is considered as

a trial for collection of data from sample of population (physicians) in order to
scientifically determine physicians status regarding group of variables and
relationship between these variables..

4.2 Population and Sample

4.2.1 Population

General practicing physicians in Pakistan three big cities RawalPindi and Islamabad
and Islamabad ought to be selected for data collection.
 4.2.2 Sample

The number of 382 general practicing physicians ought to be selected

by using Morgan’s table According to PMDC the total number of doctors in Pakistan is
110,000. The sample will be selected from the General practicing physicians in Pakistan
two big cities Convenience sampling method was adopted in order to collect the primary
data from Doctors of two big cities of Pakistan RawalPindi and Islamabad and therefore
there are the chances of error .Limited number of respondents is also the limitation of this
study. This study relied on data collection by means of the questionnaire, and the study
sample responses.

This questionnaire consisted of two sections, namely: Section One: Demographic

variables; and Section Two: Statements of the study tool. The demographic information
was collected by means of closed-ended questions, comprising seven (7) factors, namely
gender, age, study abroad, work abroad, job title, main specialty and number of year in
clinical practice. Statements of the study tool contained information relating to Direct to
doctor advertisement (six statements), Electronic detailing (five
statements), Direct to consumer advertisement (four statements),Webinar or RTD (four
Statements) , physician’s medicine adoption (five Statements) and moderating variable
role of generic medicines(Seven Statements)
 4.2.3 Scales/Measures
S.NO Constructs Instrument Scale

1 Direct to Doctor Developed by Fahad Alosaimi in (2013) 5point

advertising
Likert Scale
5=Strongly Agree
1=Strongly Disagree

2 Electronic Developed by DeKeti Ventura a , Miray 5point

Detailing Baybars a & Ayla Ozhan Dedeoglu in
2014 Likert Scale
5=Strongly Agree
1=Strongly Disagree

3 Direct to Developed by Ninya Maubach, Janet 5point

consumer Hoek in 2005 Likert Scale
Advertising
5=Strongly Agree
1=Strongly Disagree
4 Round table Developed by Masood Jawaid , Syed J. 5point
Discussion Ahmed in 2018 Likert Scale
5=Strongly Agree
1=Strongly Disagree
5 Role of generic Developed btyAggeliki V. Tsaprantzi, 5point
Drugs MD1, Petros Kostagiolas in 2018 Likert Scale
5=Strongly Agree
1=Strongly Disagree

4.2.4 Data Analysis Procedure

The data will be gathered through a questionnaire from the target population
physicians and the questionnaire comprises five Likert scales. PLS-SEM will be used
for data Analysis
6. Bibliography

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6. Tentative Time Table
Introduction : September 27, 2017
Literature Review : October 20, 2017
Analysis and Discussion : November 25, 2017
Final Submission : December 19, 2017

1. Annexure