Models and theories of prescribing decisions: A review and suggested a new model
To date, research on the prescribing decisions of physician lacks sound theoretical foundations. In fact, drug prescribing by doctors is a complex phenomenon influenced by various factors. Most of the existing studies in the area of drug prescription explain the process of decision-making by physicians via the exploratory approach rather than theoretical. Therefore, this review is an attempt to suggest a value conceptual model that explains the theoretical linkages existing between marketing efforts, patient and pharmacist and physician decision to prescribe the drugs. The paper follows an inclusive review approach and applies the previous theoretical models of prescribing behaviour to identify the relational factors. More specifically, the report identifies and uses several valuable perspectives such as the ‘persuasion theory - elaboration likelihood model’, the stimuli–response marketing model’, the ‘agency theory’, the theory of planned behaviour,’ and ‘social power theory,’ in developing an innovative conceptual paradigm. Based on the combination of existing methods and previous models, this paper suggests a new conceptual model of the physician decision-making process. This unique model has the potential for use in further research.
2. Vancelik S, Beyhun NE, Acemoglu H, Calikoglu O. Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey. BMC Public Health. 2007;7:122. doi:10.1186/1471-2458-7-122
3. Gonul FF, Carter F, Petrova E, Srinivasan, K. Promotion of prescription drugs and its impact on physicians ’ choice. J Mark. 2001;65(3):79-90. doi: 10.1509/jmkg.22.214.171.12429
4. Theodorou M, Tsiantou V, Pavlakis A, Maniadakis N, Fragoulakis V, Pavi E, Kyriopoulos J. Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey. BMC Health Serv Res. 2009;9:150. doi: 10.1186/1472-6963-9-150
5. Hemminki E. Review of literature on the d factors affecting drug prescribing. Soc Sci Med. 1975;9(2):111-116. doi: 10.1016/0037-7856(75)90103-1
6. Gallan A. Factors that influence physicians' prescribing of pharmaceuticals: a literature review. J Pharm Mark Manage. 2004;16(4):3-46. doi: 10.3109/J058v16n04_02
7. Raisch DW. A model of methods for influencing prescribing: part ii. a review of educational methods, theories of human inference and delineation of a model. DICP. 1990;24(5):537-542.
8. 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. doi: 10.1186/1748-5908-3-36
9. Ponnet K, Wouters E, Van Hal G, Heirman W, Walrave M. Determinants of physicians’ prescribing behaviour of methylphenidate for cognitive enhancement. Psychol Health Med. 2014;19(3):286-295. doi: 10.1080/13548506.2013.802361
10. Rashidian A, Miles J, Russell D, Russell I. Sample size for regression analyses of theory of planned behaviour studies: case of prescribing in general practice. Br J Health Psychol. 2006;11(Pt 4):581-593. doi: 10.1348/135910705X66043
11. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. doi:10.1016/0749-5978(91)90020-T
12. Lee HJ, Yun ZS. Consumers’ perceptions of organic food attributes and cognitive and affective attitudes as determinants of their purchase intentions toward organic food. Food Qual Pref. 2015;39(1):259–267. doi: 10.1016/j.foodqual.2014.06.002
13. Conner M, Armitage CJ. Extending the theory of planned behavior: a review and avenues for further research. J Appl Soc Psychol. 1998;28(15):1429–1464. doi: 10.1111/j.1559-1816.1998.tb01685.x
14. Prosser H, Almond S, Walley T. Influences on GPs ’ decision to prescribe new drugs - the importance of who says what. Fam Pract. 2003;20(1):61-68. doi: 10.1093/fampra/20.1.61
15. Schommer JC, Hansen RA. The study of direct-to-consumer advertising for prescription drugs. Res Social Adm Pharm. 2005;1(2):348-368. doi: 10.1016/j.sapharm.2005.03.006
16. Reyna VF, Rivers SE. Current theories of risk and rational decisionmaking. Develop Rev. 2008; 28(1):1-11. doi: 10.1016/j.dr.2008.01.002
17. Buusman A, Andersen M, Merrild C, Elverdam B. Factors influencing GPs’ choice between drugs in a therapeutic drug group. A qualitative study. Scand J Prim Health Care. 2007;25(4):208-213. doi: 10.1080/02813430701652036
18. Chen C, Dong W, Shen JJ, Cochran C, Wang Y. Is the prescribing behavior of chinese physicians driven by financial incentives? Soc Sci Med. 2014;120:40-48. doi: 10.1016/j.socscimed.2014.05.033
19. 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. doi: 10.1287/mnsc.1070.0799
20. Adorka M1, 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. doi: 10.4314/ahs.v13i2.21
21. Kotwani A, Wattal C, Katewa S, Joshi PC, Holloway K. Factors influencing primary care physicians to prescribe antibiotics in Delhi India. Fam Pract. 2010;27(6):684-690. doi: 10.1093/fampra/cmq059
22. Knight A. Patient-centred prescribing. Aust Prescrib. 2013; 6: 199-201.
23. Venkataraman S, Stremersch S. The debate on influencing doctors’ decisions : are drug characteristics the missing Link? Manag Sci. 2007; 53(11):1688 -1701. doi: 10.1287/mnsc.1070.0718
24. Tan EC, Stewart K, Elliott R, George J. Pharmacist consultations in general practice clinics: The Pharmacists in Practice Study (PIPS). Res Social Adm Pharm. 2014;10(4):623-632. doi: 10.1016/j.sapharm.2013.08.005
25. Gokcekus L, Toklu HZ, Demirdamar R, Gumusel B. Dispensing practice in the community pharmacies in the Turkish Republic of Northern Cyprus. Int J Clin Pharm. 2012;34(2):312-324. doi: 10.1007/s11096-011-9605-z
26. Knapp DE, Oeltjen PD. Benefits-to-risk ratio in physicians use when prescribing. Am J Public Health. 1972; 62(10):1346-1347.
27. Singh R. Network connectedness of pharmaceutical sales rep (FLE)-physician dyad and physician prescription behaviour: a conceptual model. J Med Mark. 2008;8(3): 257-268. doi: 10.1057/jmm.2008.14
28. Stros M, Lee N. Marketing dimensions in the prescription pharmaceutical industry: a systematic literature review. J Strategic Mark. 2015;23 (4):318-336. doi: 10.1080/0965254X.2014.931878
29. Kyle GJ, Nissen LM, Tett SE. Pharmaceutical company influences on medication prescribing and their potential impact on quality use of medicines. J Clin Pharm Ther. 2008;33(5):553-559. doi: 10.1111/j.1365-2710.2008.00948.x
30. Groves K. The influence of pharmaceutical marketing activity, practice characteristics and physician profile on physician prescribing behavior [PhD. Dissertation]. Dalhousie University, Nova Scotia, Canada, 2006.
31. Jensen MC, Meckling WH. Theory of the firm: managerial behavior, agency costs and ownership structure. J Financ Econ. 1976;3(4):305-360. doi: 10.1016/0304-405X(76)90026-X
32. Shapiro SP. Agency theory. Annu Rev Sociol, 2005;31:263-284. doi: 10.1146/annurev.soc.31.041304.122159
33. Eisenhardt M. Agency theory : and assessment review. Acad Manage Rev. 1989; 14(1): 57-74. doi: 10.5465/AMR.1989.4279003
34. Mott DA, Schommer JC, Doucette WR, Kreling DH. Agency theory, drug formularies, and drug product selection: implications for public policy. J Public Policy Mark. 1998;17(2):287-295.
35. Epstein AJ, Ketcham JD. Information technology and agency in physicians ’ prescribing decisions. RAND Journal of Economics. 2014; 45(2):422-448. doi: 10.1111/1756-2171.12057
36. O'keefe DJ. Persuasion: theory and research:Thousand Oaks, CA: SAGE; 2002. ISBN: 978-0761925392.
37. Bettinghaus EP. Persuasive communication. New York: Holt, Rinehart and Winston;1980. ISBN: 978-0030553523.
38. Storey R. The art of persuasive communication. Cambridge, England: University Press; 1997. ISBN: 978-0566078194
39. Petty R, Cacioppo J. The elaboration likelihood model of persuasion. Adv Exp Soc Psychol. 1986;19:1-24.
40. Xing JL, Othman MH. Rational decision making models might suggest what people ought to do, they are a poor guide to what people actually do. IJABM. 2015;1(1):1-5. doi: 10.24924/ijabm
41. Kotler P. Marketing Management. International Edition: Eleventh, 2003. ISBN: 978-0130497154.
42. Kotler, P. According to Kotler: The world's foremost authority on marketing answers your Questions. New York: AMACOM;2005. ISBN: 9780814472958
43. Vukadin K. Failure-to-Warn: Facing up to the real impact of pharmaceutical marketing on the physician's decision to prescribe.Tulsa Law Review. 2014;50:76-95.
44. Eccles M, Grimshaw J, Shekelle P, Schunemann H, Woolf S. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci. 2012;7:60. doi: 10.1186/1748-5908-7-60
45. 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.
46. Kramer L, Hirsch O, Becker A, Donner-Banzhoff N. Development and validation of a generic questionnaire for the implementation of complex medical interventions. Ger Med Sci. 2014;12:Doc08. doi: 10.3205/000193
47. Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, Hoagwood KE. Applying theory-driven approaches to understanding and modifying clinicians' behavior: What do we know? Psychiatr Serv. 2007 Mar;58(3):342-348. doi: 10.1176/ps.2007.58.3.342
48. 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. doi: 10.1016/j.socscimed.2015.03.028
49. Raven H, Schwarzwald J, Koslowsky J. Conceptualizing and Measuring a Powerllnteraction Model of Interpersonal Influence. J Appl Soc Psychol. 1998;28(4):307-332. doi: 10.1111/j.1559-1816.1998.tb01708.x
50. Busch P, Wilson D. An experimental analysis of a salesman’s expert and referent bases of social power in the buyer-seller dyad. J Mark Res. 1976;13(1): 3-11.
51. French JRP, Raven B. The bases of social power. In: Cartwright D (Ed). Studies in Social Power. Ann Arbor, MI: University of Michigan Press;1959. ISBN: 978-0879442309.
52. Rigby D. Collaboration between doctors and pharmacists in the community. Aust Prescr. 2010; 23(6):191-193. doi: 10.18773/austprescr.2010.088
53. Stremersch S, Van Dyck W. Marketing of the life sciences. A new framework and research agenda for a nascent field. J Mark. 2009;73(4):4-30. doi: 10.1509/jmkg.73.4.4
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