Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan.
Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2022 Nov 4;12(11):e067233. doi: 10.1136/bmjopen-2022-067233.
In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data.
Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion.
ISRCTN12294839.
在私营部门构成更大一部分医疗体系的环境中，逐利可能优先于患者的福祉。在与制药公司的互动中，私人全科医生（GP）可能会经历利益冲突（COI），即 GP 专业决策的公正性可能受到经济利益等次要利益的影响，例如开特定品牌药物的经济收益。
本研究是一项随机对照试验，旨在评估多方面干预对 GP 医疗实践的影响。研究样本包括 419 名拥有/在私人诊所工作的注册全科医生，他们将被随机分配到干预组和对照组。干预组 GP 将接受关于医学伦理的情感和教育研讨会，而对照组 GP 将参加关于一般医学主题的研讨会。主要结局指标将是 GP 的处方实践，次要结局指标将是他们对源于制药激励的 COI 的知识和态度。除了新颖的标准化制药代表（SPSR）方法外，研究人员还将在预调查和后调查中使用现场研究人员与 GP 模拟制药营销，进行定性访谈，以收集与制药激励相关的 COI 相关的 GP 知识、态度和实践的数据。将进行单变量和多变量统计分析，以衡量 GP 知识、态度和实践的变化，同时定性分析将增加我们对定量 SPSR 数据的理解。
巴基斯坦国家生物伦理委员会（#4-87/NBC-582/21/1364）、阿迦汗大学（#2020-4759-1129）和伦敦卫生与热带医学学院（#26506）已批准该研究。我们将在研究完成后 6-9 个月内发布结果。
ISRCTN826506。
