Table 1. Characteristics of included studies on physicians’ interactions with the pharmaceutical industry.
| Study ID | Sample size and funding | Participants and settings | Sampling frame and method | Type of interaction | Outcomes assessed |
|---|---|---|---|---|---|
| Blake, 1995[52] | • N = 486 • Funding not reported |
• Adults (I8 years of age and older) in two family practice centers • Columbia, USA; June and July 1994 • 63.2% females; mean age (SD): 40.6 (±15.8) • Education: 48.4% some college or college graduate; 17.1% postgraduate degree |
• Frame: Adults in two family practice centers operated by the University of Missouri-Columbia, Medicine. • Method: Convenience sampling |
• Free drug samples • Ballpoint pens • Medical books • Baby formula • Dinner at a restaurant • A coffee maker |
• Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Beliefs about their effects on cost of care • Attitudes towards the interactions |
| La Puma, 1995[53] | • N = 200 • Funding not reported |
• Patients (18 years and above) in a general medical office • USA • 64% females; mean age (range): 49.7 (18 to 87 years) |
• Frame: Patients 18 years and above in a general medical office. • Method: Convenience sampling |
Financial payment for taking part in post marketing research for drugs | • Beliefs about their effects on prescription behavior and quality of care • Attitudes towards the interactions • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction |
| Mainous, 1995[54] | • N = 649 • Funding not reported |
• Kentucky residents (18 years of age and older) • Kentucky, USA • 55% females; mean age (SD): 47± 16 • Education: 72% high school or above |
• Frame: Data base of phone numbers • Method: stratified random sampling |
• Office use gifts (e.g., samples, pens, notepads) • Personal gifts (clocks, radios, or dinners at expensive restaurants) |
• Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Beliefs about their effects on cost of care • Attitudes towards the interactions |
| Gibbons, 1998[55] | • N = 196 (100 at military site and 96 at civilian site) • Funding not reported |
• Patients at two medical centers • USA • 65–67% female; mean age (range): 61 (21–89) at military site, 60 (24–90) at civilian site • Education: college graduate: 29% at military site; 3.2% at civilian site |
• Frame: Patients at two tertiary-care medical centers, one military and one civilian, at Washington, DC. • Method: Random sampling at military center, convenience sampling at civilian center. |
• Trip • Dinner • Pocketknife • Lunch • Mug • Drug sample • Large text; small text • Pen • Video |
• Awareness of the interactions of own physicians • Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Attitudes towards the interactions |
| Qidawai, 2003[56] | • N = 420 • Funding not reported |
• Patients attending outpatient tertiary care hospital • Pakistan; December 1999 to May 2000. • 11.2% females; mean age (SD): 33.7 (±11.98) • Education: 34% graduate |
• Frame: Patients attending outpatient settings of a busy tertiary care hospital • Method: Convenience sampling |
Accepting gifts from pharmaceutical companies | • Attitudes towards the interactions |
| Semin, 2006[57] | • N = 584 • Funded by a research grant from the Dokuz Eylul University, Turkey |
• Patients admitted to the primary health care centers in Izmir Centrum • Turkey; December 2004 • 64.7% females; mean age (SD): 42 (± 15.4); 34.9% with chronic disease • Education: 21% university |
• Frame: Patients who had been admitted to the primary health care centers in Izmir Centrum, the third largest city in Turkey. • Method: Stratified systematic sampling |
• Obtaining medical devices for office • Invitation to the conferences for the week-end at hotels • Conference and dinner • Middle level gifts • Invitation for the congresses • Medical booksLow level gifts e.g. pen |
• Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Beliefs about their effects on cost of care • Attitudes towards the interactions • Attitudes towards the effects of interactions on trust • Attitudes towards possible ways to manage the interactions: - Regulation of interaction |
| Edwards, 2009[58] | • N = 134 • Supported by Donaghue Initiative at Yale University Interdisciplinary Bioethics Center |
• Employees of The Age newspaper in Melbourne • Australia; 18 January and 8 February 2007 • 57.8% female; age: 40% 31–43, 34.1% 18–30, 25.3% 44–65 • Education: 37.6% Bachelor’s degree; 14.5% postgraduate degree; |
• Frame: employees of The Age newspaper in Melbourne. N = 1524 • Method: Convenience sampling |
Pharmaceutical marketing activities ranging from largesse such as small gifts and free drug samples, to the sponsorship of educational conferences | • Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Attitudes towards the interactions • Attitudes towards the effects of interactions on trust • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction - Method of disclosure |
| Jastifer, 2009[59] | • N = 903 • Supported by Upper Peninsula Health Education Corporation, Michigan State University |
• Adult residents (18 years and older) who reside in Alger County • Michigan, USA • 63.1% females; age: 12.8% aged 18–40, 39.5% aged 41–60, 47.7% older than 60 • Education: 50.7% high-school graduate or some college; 34.8% college graduate or postgraduate degree |
• Frame: List of postal addresses • Adult residents, 18 years and older, who reside in Alger County, in rural Michigan.” • Method: Convenience sampling |
• Drug samples • Ballpoint pens • Medical books • Conference/travel expense • Dinner out • Spouse meal at dinner out • Golf tournament fees |
• Awareness of the interactions of physicians in general • Beliefs about their effects on prescription behavior and quality of care • Beliefs about their effects on cost of care • Attitudes towards the interactions • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction |
| Tattersall, 2009[60] | • N = 906 • Funding not reported |
• Patients in the waiting rooms of three general practices • Australia; October to November 2007 • 48.5% female; mean age (SD): 51.2 (±104.7) • Education: 71.3% undergraduate or postgraduate university degree |
• Frame: Three general practices in metropolitan Sydney • Method: Convenience sampling |
• Benefits in cash or in kind • Financial incentives for participation in research activities • sponsor for travel • Registration or accommodation to attend conferences • Indirect benefit /financial incentive for instituting treatment course, prescribing a drug, making a referral, doing test or procedure, enrolling patients in trial |
• Awareness of the interactions of own physicians • Beliefs about their effects on prescription behavior and quality of care • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction - Method of disclosure |
| Macneill, 2010[61] | • N = 757 • Supported by National Health and Medical Research Council of Australia |
• General public (over the age of 18 years) from the electoral roll of the Hunter region • New South Wales, Australia • 59% female; average age (SD): 52.2 (±16.2) • Education: 20% university degree or currently attending a university |
• Frame: Electoral roll of the Hunter region of New South Wales • Adults of New South Wales over the age of 18 years • Method: Random sampling |
• Gifts with potential • benefit to patients (e.g. leaflets, drug samples, appointment books, flashlight) • Office-use gift (e.g. • pens, Spirometer/ECG machine stethoscope, surgery computer) • Personal gift • (conference, ticket, laptop) |
Attitudes towards the interactions |
| Grande, 2012[62] | • N = 2,029 • Funded by National Human Genome Research Institute, American Cancer Society |
• Adults in 10 large metropolitan areas • USA; June -December 2006 • 63.2% female; age: 8.4% aged 18–39, 62.2% aged 40–64, 29.4% aged 65 and above • Education: 28.2% some college; 35.3% 4-year college degree or graduate school. |
• Frame: A database of phone numbers • Method: Cluster random sampling |
Pharmaceutical industry–physician gift relationships | • Awareness of the interactions of own physicians • Awareness of the interactions of physicians in general • Attitudes towards the effects of interactions on trust |
| Green, 2012[63] | • N = 192 • Funding not reported |
• English-speaking adults in outpatient clinics waiting rooms • USA; 2008 • 61% female; mean age (range): 53 (18–89) • Education: 45% high school graduate or some college; 46% college graduate or more |
• Frame: patients in waiting rooms of five outpatient clinics at a mid-Atlantic academic medical center. • Method: Convenience sampling |
• Accepted large gifts • Attend drug company social activities and trips • Accepted small gifts • Gave lecture • Conducted research for drug company • Accepted industry-sponsored meals |
• Awareness of the interactions of own physicians • Beliefs about their effects on prescription behavior and quality of care • Attitudes towards the interactions • Attitudes towards the effects of interactions on trust • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction |
| Wise, 2012[64] | • N = 200 • Funding not reported |
• Postoperative South African patients from four surgical wards in a teaching hospital • South Africa; March- Nov 2011 • 67% females; age: 17% aged 18–24, 73% aged 25–64, 10% 65 or above • Education: Not reported |
• Frame: Postoperative adult patients at Grey’s Hospital, Pietermaritzburg. • Method: Convenience sampling |
• Samples; • Small gifts (e.g. pens, notepads) • Fees for speaking at industry -sponsored conferences • Free food and dinners • Travel or holidays |
• Beliefs about their effects on prescriptive behavior and quality of care • Attitudes towards the interactions • Attitudes towards the effects of interactions on trust • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction |
| Camp, 2013[50] | • N = 503 • No external funding sources |
• Postoperative arthroplasty patients attending follow up hip and knee arthroplasty clinics • USA & Canada; Nov 2010-March 2011 • 55% females US; 59% females Canada; age: 36% < 60, 64% 60 and above for US; 30% < 60, 69% 60 and above for Canada • Education: US (51% college /university degree; Canada (51% college/university degree |
• Frame: postoperative patients attending follow up hip and knee arthroplasty clinics at Mount Sinai Hospital and Holland Orthopaedic • Method: convenience sampling |
Financial relationships with manufacturers (gifts, royalties, consultancy payments, speakers’ bureau presentations, or research support) | Awareness of the interactions of physicians in general |
| Holbrook, 2013[65] | • N = 1041 • Funded by Canadian Institutes of Health Research |
• Adult population (18 years of age or older) who speak English or French and reside in private homes • Canada; May-September 2010 • 56.8% female; mean age (SD): 52.6 (16.5) • Education: 57.7% college or higher |
• Frame: A database of phone numbers Method: Stratified random sampling. | • Requesting information about a particular drug • Educational gifts to patient • Free meals to listen to industry personnel • Payment to attend conference • Research recruitment fees • Medication samples |
Attitudes towards the interactions |
| Oakes, 2015[51] | • N = 31 (a total of six focus groups) • Funding not reported |
• Patients from three of the academic health center’s clinics (orthopedic surgery, cardiology and dentistry) • USA, Twin Cities area Minnesota; nine-week period (no data) • 74% female; mean age: 55 • Education: 65% college |
• Frame: Participants 18 years and older from three clinics (orthopedic surgery, cardiology and dentistry) in one academic health center • Method: convenience sampling |
Conflict of interest relating to physician interaction with the industry | • Attitudes towards the interaction • Attitudes towards the effects of interactions on trust • Attitudes towards possible ways to manage the interactions: - Disclosure of interaction - Methods of disclosure |