GPs’ perceptions of their relationship with the pharmaceutical industry: a qualitative study

Problem

The pharmaceutical industry invests heavily in promoting medications to physicians. This promotion is associated with inappropriately increased prescribing rates, lower prescribing quality, and/or increased prescription costs. GPs are likely to be an important promotional target for the pharmaceutical industry because they are high initiate a high proportion of patient prescriptions. Ireland offers an interesting case study, as the regulatory environment is similar to many European countries. This study therefore aimed to understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction on general practice in Ireland.

Approach

A qualitative design was used, and GPs practicing in Ireland were eligible. A phenomenological approach was applied in order to gather rich, in-depth data and gain a better understanding of GPs’ perceptions and everyday experiences. A combination of purposive and snowball sampling was used to recruit participants. Semi-structured interviews were conducted. Thematic analysis, following a six-step process, was used to develop themes from the data.

Findings

Twenty-one GPs and one GP trainee participated. Five themes were developed: (1) GP and pharmaceutical industry interface, (2) the industry’s methods of influence, (3) the uncomfortable relationship between GPs and industry, (4) GPs’ perceptions of being unconsciously influenced, and (4) GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biased information and the offer of gifts. Some participants chose not to meet with pharmaceutical representatives. Most participants felt their prescribing was unconsciously influenced by pharmaceutical representatives. A minority felt that they were only influenced in a way that improved their prescribing.

The study shows that GPs in Ireland are interacting with pharmaceutical representatives in a variety of contexts. Also, that there can be a lack of clarity among GPs about relevant regulations and about the potential impact of interactions with the pharmaceutical industry on prescribing.

Consequences

These findings provide an in-depth understanding of the processes involved in the relationship between the pharmaceutical industry and GPs as well as an understanding of the variation in GPs’ perceptions of the industry and its potential influence over their profession. This can inform strategies to ensure an appropriate relationship between GPs and the pharmaceutical industry.

Educational bodies should consider providing more education on regulations, guidelines, and best-practice surrounding interactions with the pharmaceutical industry. As evidenced by this research, some educational groups and GP practices have a policy of not interacting with the pharmaceutical industry. Introducing these policies more widely, has the potential to reduce the impact of pharmaceutical representatives on prescribing. However, alternative educational funding for CPD would need to be established.