Factors influencing prescribing behaviour of physicians in Greece and Cyprus:
Results from a questionnaire based survey
M. Theodorou1, V. Tsiantou2, N. Maniadakis2, D. Kaitelidou3, V. Fragoulakis2, E. Pavi2, J. Kyriopoulos2
1Open
University of Cyprus, Postgraduate Programme in Health Care Management
School of Public Health, Athens, Department of Health Services Organization & Management
3 National and Kapodistrian University of Athens, Faculty of Nursing
2
Problem Statement: Pharmaceutical and overall health expenditure have risen rapidly over the
past few decades in most western countries. This negative development was a reason for
serious concern to policymakers, who have reacted with major reforms, using different tools
and implementing various measures to increase clinical efficacy and economic efficiency and
hence guarantee the sustainability of health care systems
Objectives: To investigate the attitudes and factors influencing physicians prescribing decisions
and their drug prescription choices in Greece and Cyprus.
Design: A cross-sectional study was carried out using a structured questionnaire developed by
researchers at the Department of Health Economics at the National School of Public Health in
Greece. The questionnaire was being posted to doctors with a prepaid return envelope.
Setting: The study was conducted simultaneously in Greece and Cyprus by the National School
of Public Health (Greece) and Open University (Cyprus). The participating physicians were
working either in the private or in the public sector, as well as in primary or secondary care.
Study Population: Sample of 1463 physicians in Greece and 240 in Cyprus, randomly selected
and stratified by sex, specialty and geographic region.
Results: The response rate was 82.3% in Greece and 80.4% in Cyprus. Regarding the finding
there were similarities but also many differences between the two countries. Clinical
effectiveness is the most important factor considered in drug prescription choice in both
countries (94.8% in Greece vs 93.3% in Cyprus). Greek physicians were significantly more likely
to take additional criteria under consideration, such as the drug form, (38.2% vs 9.8%, p<0.001)
the recommended daily dose, (35.5% vs 4.1%, p<0.001), the cost to the patient, (41.9% vs 8.3%,
p<0.001) and the patient preferences, (11.0% vs 0.5%, p<0.001). The main sources of
information for physicians include: peer-reviewed medical journals, (73.7% vs 58.5%, p<0.001)
medical textbooks, (60.7% vs 44.0%, p<0.001) medical congress announcements (70.3% vs
69.4%) and pharmaceutical sales representatives, (52.0% vs 61.1%, p=0.016). The majority of
doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may
not be excellent, but acceptable. However, 66.8% of Cypriot physicians prescribe generics,
whereas in Greece the percentage is only 25.2%. The majority of physicians (82.1% vs 63.2%)
believe that new drugs are not always better and their higher prices are not necessarily justified.
Regarding adverse drug reactions the majority of physicians are informed primarily by the
National Organization of Medicines, (65.7% in Greece vs 48.7% in Cyprus) and secondly by sales
representatives, (42.6% vs 42.0%). However, 62.6% of doctors in Greece and 88.1% in Cyprus
(p<0.001) does not inform the authorities of such adverse drug reactions.
Conclusions: The present study underlines the attitudes and the factors influencing physicians’
behaviour in Greece and Cyprus and may be used for developing policies to improve their
choices and to increase clinical and economic efficiency.
Funding Source(s): National School of Public Health (Greece) and Open University of Cyprus
(Cyprus)
Key Words: prescribing behavior, prescribing practice, Greece, Cyprus