1. Interactions between doctor and pharmaceutical representative in eastern context, Varalak Srinonprasert 2009 Write Workshop Target Journal: JAMA

2. Interactions between doctor and pharmaceutical representative in eastern context, how do we differ from weterners Varalak Srinonprasert 2009 Write Workshop Target Journal: JAMA

3. Background Significance of interactions –Amount of interactions has been increasingly concerning in western countries –Influence of interactions on medical field have been evidenced both on positive and negative sides –Effect on personal level : influence on doctors’ prescribing behaviors Inappropriate prescribing behavior could lead to unnecessarily increasing in amount of money spent on healthcare cost This problem has been under-recognized by individual

4. Background Factors influencing attitude of doctors toward interactions between pharmaceutical representatives and physician –Previous studies showed multiple factors affecting amount of interactions such as studied site, level of profession and specialty –Level of profession and specialty have been aspects of interested with mixed result from previous studies

5. Background Comparing two groups of medical professions with multiple specialty might give additional insights into factors influencing interactions –Previous studies comparing different level of medical profession showed conflicting effects on different type of interactions –Specialty has been shown to influence on interactions –Previous studies conducted in one level of medical profession with multiple specialties or 2 levels of medical profession but one specialty –Many studies has limited factors to take into account in analysis

6. Background Study in Thai context might give different insights –Cross-culture difference in attitude between easterners and westerners affecting various behaviors –It is unknown whether “ Kreng Jai” ; a common Asian culture would effect on amount of interactions and doctors’ attitudes

7. Research Questions Why do physicians(residents) interact with pharmaceutical representatives? How different are the amount of interactions and factors influencing on the interactions in Thailand compare to other settings where the relationship has been studied?

8. Methodology Included population : pre-training and in-training physicians at a university hospital with training programs in 14 specialties Questionnaire development –Items selection –Construct validity 3-pages questionnaire was distributed to all trainees

9. Analysis  Proportion presented in percentage  Chi-square test used for comparing  Odd ratios used for comparing odds of having interactions or not  Logistic regression models applied for adjusting confounding variables

10. Results Response rate : 71.6% 232 pre-training and 458 in-training physicians Mean age 28 years old 54 % female

11. Results InteractionsPre- training In-trainingp-value Having conversations 74.5%74.4%1.00 Receiving gifts 88.7%89.6%0.80 Receiving non- educational gifts 57.4%43.7%0.001 Table 1 : Proportion of trainees having interactions Non-educational gifts include : meal without academic activities, trips and social outings/ticket

12. Factors associate with having interactions VariablesPre-trainingIn-training Having conversations Gender Gender, year of training, department, positive attitude toward interactions, perception of pt’s attitude, observing role model Receiving non- educational gifts Agree to statement ‘ it is impolite to decline offers’ Gender, year of training, department, positive attitude toward interactions, perception of pt’s attitude, observing role model

13. Discussion/Conclusion Proportions of interactions were high, comparable to studies done in USA Interestingly, proportion of in-training physician is significantly higher for receiving non-educational gifts

14. Discussion/Conclusion “ appropriateness of accepting gifts” differ both between different level of medical professionals and doctors and patients Perception of acceptance might be put more on price than educational-related items, previous study has shown this

15. Discussion/Conclusion Factors influencing interactions Differences seen between in-training and pre-training physician are intriguing Factor perceived as cultural-based attitude (‘kreng jai’) has influence on pre-training physician while this influence has been eliminated by other factors after being in training program Could be a potential modifiable factors to intervene on for training physicians

16. Thank you for your attention