A systematic review of the influence of medical representatives and promotional tools on prescribing : A comparison between developed and developing countries

Purpose The purpose of this paper is to examine reported literature on the influence of medical representatives (MRs) and other promotional tools on drug prescribing behaviour, and to assess whether this effect is different in developed and developing countries. Design/methodology/approach A survey of the literature was conducted across online databases from 2000 to 2016. Eligible studies addressed MRs and other promotion tools used to influence drug prescribing in developed and developing countries. Findings A total of 40 reviewed studies met the inclusion requirements. In total, 22 of the studies were conducted in developed countries and 18 in developing countries. Out of ten studies that examined the influence of MRs on drug prescribing in developed countries, eight found a positive influence, one found only moderate and one finds no influence. Analogous results were found in developing countries. Six out of ten studies on the influence of MRs conducted in developing countries found a positive effect, three found only moderate effects, while one finds no influence. The influence of promotion tools on prescribing varied in developed countries, five found positive influence, four reported a small effect and one found negative influence. In developing countries, the size of effect also varied, five studies found positive influence of promotion tools on drug prescribing behaviour, five found a negligible or small effect, and one found no association. However, marked differences were observed between two sectors. In the developed countries, MRs are valued as a source of information and can have an effect on prescribing, while it is unreliable in developing countries. Sample drugs are more generally seen as an important promotional tool for prescribing in developed countries than developing countries. Research limitations/implications The results derived from this review are based on studies with varying methodological consistency. The review provides the crucial information that will be valuable to researchers working on comparative analysis of marketing efforts in developing and developed countries. Originality/value This paper is one of the few systematic reviews on the influence of MRs and other promotional tools on prescribing. It compares the influence of MRs and promotional efforts in both developed and developing countries.