BAHADUR ALIMSc.N studentINSTITUTE OF NURSING

DOW UNIVERSITY OF HEALTH SCIENCES

KARACHI

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Nurses’ Perceptions related to Interaction of Medical Representatives with Doctors and Nurses

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huge number of medical representatives are seen in OPDs, Wards, clinics

busy in interaction with doctors and rarely with other health professionals

to promote their new products.to influence doctor’s prescription behavior (Lexchin, 1993; Fugh-Berman & Ahari 2007) through offering gifts, dinners, and other incentive such as paying cost all travelling and educational symposiums to increase drug sales (Wazana, 2000; Crigger, 2005)

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Accepting gifts from pharmaceutical companies is a relative conflict

of interest from the perspective that all the costs they spend on gifts

and other drug promotion activities are added to the cost of the

medication for the patient (Chimonas & et al 2007).

While Physician argued that interaction with medical representative

do not influence on their prescription behavior (Hodges,1995;

Chimonas & et al 2007; Korenstein, Keyhani, & Ross, 2010)

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Patient concerns that drug representative’s relationship with doctors influence doctors to prescribe their medication (Gibbons & et al, 1998; Mainous, Hueston & Rich, 1995),

instead of patient needs particularly when drug representative present in doctors’ room that may shows a threat to patients’ trust in doctors (Goff, Mazor, Meterko, Dodd & Sabin, 2007).

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These controversies are directly concerned and impacting on our patient’s health out comes and morality of health care providers including nurses (Mainous, Hueston, & Rich, 1995; Gibbons & et al. 1998).

Unfortunately, nurses who interact with medical representatives during drug promotion and get opportunity to participate in medical workshop have less awareness about ethical aspects of these issues.

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The purpose of this study is to explore Nurses perceptions related to interaction of medical representatives with doctors and nurses to determine ethical issues related to patient's health care

needs.

Lacking in ethical knowledge of nurses toward pharmaceutical representatives’ interaction.

Being a part of health care system nurses are more prone to be influenced by pharmaceutical

representatives during their practice. The majority of Pakistani researches has identified

doctors role on this topic but no single research has addressed nurses perspective and role who

have the key role in drug administration to patients.

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How nurses perceive the interaction of medical representatives with doctors and nurses?

How interaction of medical representatives with doctors and nurses ethically impact on patients’ health care

needs?

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Study design

Descriptive

subjects’ description, and sample

(still no any such quantative study is conducted regarding Nurses perception related to interaction with medical representatives. So I am selecting 100 charge nurses sample due to limited time of study duration)

Study subjects will be 100 Charge Nurses working at Jinnah Postgraduate Medical Centre JPMC, Karachi

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Study Setting and Duration

Research will be conducted at JPMC, Karachi.

03 Months Period of time. (from 1st April 2014 to 30 June 2014)

Sampling Technique

Purposive

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Inclusion criteria

Charge Nurse having at least 2 years experience at JPMC, Karachi

Attended at least one time Medical Seminar/ CME workshop

Exclusion criteria

Refuse to give written informed consent

Method of Data CollectionQuestionnaires

(Saira Baloch* et al. International journal Of Pharmacy & Technology)

Ethical ConsiderationApproval will be taken from IRB.

written informed consent from participant

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Name: age: ……..years Design: sex :

Qualification: Professional experience:

1. It is unethical for a nurse to accept a gift of any type from medical representative. (1) agree (2) neutral (3) disagree

2. I would feel no harm in accepting following gifts from a pharmaceutical company: pens, house hold gadgets, lunch, stethoscope, textbook etc.

(1) agree (2) neutral (3) disagree

3. The information provided by MRs about the effectiveness of new product is trustworthy. (1) agree (2) neutral (3) disagree

4. The information provided by MRs about the effectiveness of older drug is trustworthy. (1) agree (2) neutral (3) disagree

5. The nurses should not have any interaction with medical representatives at their working place. (1) agree (2) neutral (3) disagree

Nurses’ Perceptions related to Interaction of Medical Representatives with Doctors and Nurses

6. If three drugs from three different drug companies are same in term of price, effectiveness and efficacy. I would prefer to prescribe the drug from the company which will provide me gifts and incentives over those companies that did not.

(1) agree (2) neutral (3) disagree

7. Drug representatives should not banned from making presentations in this institute/ ward.

(1) agree (2) neutral (3) disagree

8. Interactions with drug representatives have no impact on physician's prescribing behavior.

(1) agree (2) neutral (3) disagree

9. It is acceptable for pharmaceutical companies to sponsor educational seminars and events during nursing training.

(1) agree (2) neutral (3) disagree

10. I have sufficient knowledge about interaction with Medical representatives. (1) agree (2) neutral (3) disagree

11. I would always maintain the same degree of contact with MRs if no gifts or foods were distributed.

(1) agree (2) neutral (3) disagree

12. Drug representatives employ marketing techniques in their interactions with residents. (1) agree (2) neutral (3) disagree

13. It is ethical to accept marketing gifts having patient benefit e.g. Drug samples. (1) agree (2) neutral (3) disagree

INFORMED CONSENT FORMTitle of study:Title of study: Nurses` perception related to interaction of medical representatives with doctors and nurses.

Principal Investigator: BAHADUR ALIInstitute: Institute Of Nursing, Dow University of Health Sciences Karachi.Purpose of Study:: To explore Nurses` perceptions related to interaction of medical representatives with doctors and nurses and to determine ethical issues related to patients` health care needs.Procedure: In this study we will ask you few questions about perceptions related to interaction of medical representatives with doctors, nurses and its` ethical issues related to patients` health care needs. Interviews will be conducted at your job place through a Questionnaire this will take about half an hour. All information will be kept secret to maintain confidentiality.Possible risk or benefits:There is no risk involved in this study except your valuable Time. There is no direct benefit to you also.

Confidentiality: The information provided by you will remain confidential. No body except principal investigator will have an access to it. Your name and identity will also not be disclosed at any time. Your name identity will not be disclosed in any publication of this research.Available sources of information: If you have any question you may Contact principal investigator: BAHADUR ALI MSc Nursing Student at institute of Nursing Dow University of Health Sciences. Contact # +92301-2668673, +92333-8272955Authorization:I have read and understand this consent form and I volunteer to participate in this research study. I understand that my consent does not take away any legal rights in the case of negligence or other legal fault of anyone who is involved in this study. I further understand that nothing in this consent form is intended to replace any applicable Federal state, or local laws.Participant Name: _________________ Signature: ________________ Date: / /2014Principal investigator: BAHADUR ALI Signature: ________________ Date: / /2014Consent taken by: _________________ Signature: _________________Date: / /2014

Medical representative: (MR) Medical sales representatives (widely referred to as reps) are a key link between medical and pharmaceutical companies and healthcare professionals.

(https://www.google.com.pk/?gws_rd=cr&ei=x4coU66pMJGthQfd_oGgCQ#q=Medical+representative+means)

Perception: the act or faculty of perceiving, or apprehending by means of the senses or of the mind; cognition; understanding.

(http://dictionary.reference.com/browse/perception)

Ethic : A system of accepted beliefs which control behavior especially such a system based on morals.

(Advance learner's dictionary CAMBRIDGE university press 2nd edition)

CME: Continuous Medical Education.

My research shall be conducted at Jinnah Institute of post graduate & medical Sciences karachi. I shall get approval from IRB and Department then approaches to different wards and OPDs where mostly medical representatives visits.

100 those Staff Nurses who have at least 2 years of practical experience and also will have participated in at least one CME will be included after selection, take informed Consent from participants then structured Questionnaires will be filled out.

1st of all I will enter data through EpiData software.

After successfully entry of all data check and then create spss file.

On SPSS software (16 version) apply descriptive statistics /Frequency percentage

Sr.No. Subject/Activity

Duration

Week #

1st Aprto

7th apr 2014

8th AprTo

14th apr 2014

15th Aprto

30th apr 2014

1st may to

30th may 2014

1st Juneto

20th June 2014

21st June to

31st June 2014

1 Introduction (Writing) 1 Weeks            

2 Methodology 1 Weeks            

3 Questionnaire Development

2 Weeks            

4 Data Collection 4 Weeks            

5 Data Analysis 3 Weeks            

6 Completion of Research 1 Weeks            

Total 12 Weeks (3 months)

S.NO

ITEMS COSTApproximately in pak

rupees

1 Traveling Expenses 5000/=

2 Questationnaire & consent form printing

2000/=

3 Stationary 1000/=

4 Others 2000/=

5 Total 10000/=