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Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information
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Beyond the Web-Based e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information

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Dissertation submitted in partial fulfillment of the requirement for the degree of Master of Science in Advanced Information Technology and Business Management (MSCAITBM).

Dissertation submitted in partial fulfillment of the requirement for the degree of Master of Science in Advanced Information Technology and Business Management (MSCAITBM).

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  • 1. ROBERT KENNEDY COLLEGE AT UNIVERSITY OF WALES Dissertation Submitted in Partial fulfillment of the requirement for the Degree of Master of Science in Advanced Information Technology And Business Management (MSCITBM) Title:“Beyond the Web-Based ‘DTP’ e- Communication Dashboard: Unleashing the True Value of Pharmaceutical and Clinical Information” Prepared by: Adel A.M. Seedahmed Supervisor: Professor. Carol Marrow July 21, 2011 1
  • 2. Declaration of originality"In presenting this dissertation for assessment, I declare that it is a final copy including anylast revisions. I also declare that it is entirely the result of my own work other than wheresources are explicitly acknowledged and referenced within the body of the text. [Or: infootnotes, end notes, as appropriate]. This dissertation has not been previously submitted forany degree at this or any other institution 2
  • 3. TABLE OF CONTENTAbstract……………………………………………………………………………..…………7Acknowledgement…………………………………………………………………………......9Title……………………………………..……………………………………………………101.0 CHAPTER ONE: INTRODUCTION1.1 Problem overview……………………………………………………………………......111.2 Research rational………………………………………………………………………....131.2.1 Pharmaceuticals marketing expenditure …………………………………………….…131.2.2 Research and development ‘R&D’…………………….….……….…………......……141.2.3 Leveraging evidence-based medicine ‘EBM…………………………………………..161.3 Research objective………………………………………………………………………..171.4 Research questions…………………………………………………………………….....191.5 Research topics…………………………………………………………………………...202.0 CHAPTER TWO: LITERATURE REVIEW2.1: The evolution of information technology ‘IT’ and electronic commerce‘e-commerce’ in business development2.1.1 The role of information technology ‘IT’ in business development……………….....…212.1.2 The role of electronic commerce ‘e-commerce’ in business development….................22 3
  • 4. 2.1.3 e-detailing diverse platforms……………………………………………………….......232.1.4 Web-based media partners…………………………………………….……….........…242.2 The potential benefits and main challenges of ‘IT’ and e-detailing…………….…252.2.1 Company perspectives…………………………………….…………………................262.2.2 Customer relationship management ‘CRM’ technologies……………………..………272.2.3 Product life cycle management ‘p-LCM’……………………………………....………282.2.4 Branding………………………………………………………………………..………302.2.5 Online disease awareness………………………………………………………..….….312.2.6 Pharmacovigilance alerts…………………………………………………………….....322.2.7 Social networking site……………………………………………………………….…332.2.8 Physicians and healthcare perspectives……………………………………………...…332.2.9 Main challenges of ‘IT’ and e-detailing………………………………………………..353.0 CHAPTER THREE: RESEARCH DESIGN3.1Mixed methods research………………………..………………………………………363.1.1 Development of grounded theory……………...………………………………….……373.2. The Qualitative method……………………..………………………………………393.2.1 Methodology……………………………………..……………………………….……393.2.2 Pilot interviews test…………………………………………………………………….393.2.3 Sample selection………………………….……………………………………….……403.2.4 Preparation of interview………………………..………………………………………40 4
  • 5. 3.2.5 Ethical issues, privacy and confidentiality of research participants……...………….…413.2.6 Data collection………………………………………………………………………….413.2.7 Reliability and validity…………………………………………………………………423.2.8 Data analysis and presentation…….……………..…………………………….………423.3The Quantitative method…………………………………………………..…………433.3.1 Methodology………………………………………..….………………………………433.3.2 Questionnaire testing…………………………………………………………………...443.3.3 Sample selection………………………………………………………………………..443.3.4 Ethical issues of research participants……………………………………….…………453.3.5 Privacy, confidentiality, and anonymity of research participants…………..………….463.4 Data Collection, Data Capturing, Descriptive Statistics, Validity and Reliability.463.4.1 Data collection……………………………………………………………………........463.4.2 Data capturing……………………………………………………………….…………473.4.3 Descriptive statistics…………………………………………………….…...…………483.4.4 Validity and reliability………………………………………………………………....514.0 CHAPTER FOUR: DATA RESULT, DESCRIPTIVE STATISTICS, ANDSTUDY FINDINGS4.1 The qualitative data result……………………………………………………………......534.2 The quantitative data result……………………………………………….….………......564.2.1Technology Acceptance Model ‘TAM’ variables…………….………...........................56 5
  • 6. 4.2.2 Technology Acceptance Model ‘TAM’ variable’s responses………………....……….584.2.3 Descriptive statistics……………………………………………………………………624.2.4 Study findings……………………………………………………………….…………645.0 CHAPTER FIVE: CONCLUSIONS RECOMMENDATIONS, ANDSTUDY LIMITATIONS5.1 Conclusions…………….……………………………………………………………......665.2 Recommendations…………………………………………………………………..……685.3 Study limitations……………………………………..……………………………….….69REFERENCES AND BIBLIOGRAPHY……………………………….……………71LIST OF APPENDICESFigure.1 Technology Acceptance Model ‘TAM’……….………………………………......100Figure: 2 Marketing expenditure of top five companies…………………………………....100Figure: 3 Useful Evidence-Based Medicine ‘EBM’ URLs……….…………….……….….100Figure: 4 Questionnaire categories……………………………………………………….....101Figure: 5 Sample questionnaires……………………………………………………………101Figure: 6 Questionnaire multi items statements…………………………………………….103Figure 7: Technology Acceptance Model ‘TAM’ variables’ responses…………………....104Figure 8: Perceived usefulness items responses……………………………………….........105Figure 9: Perceived ease of use items responses………………………………...………….106Figure 10: Attitude items responses…………………………………………….....………107Figure 11: Behavioural intention items responses……………………………….....………108 6
  • 7. AbstractThe evolution of information technology ‘IT’ and electronic commerce ‘e-commerce’, mayprovide a leading pharmaceutical company with a complementary electronic communicationchannels for legitimating ethics, strengthening communication, building trust, andmaintaining a convenient relationship among the physicians, the healthcare professionals, andthe broader medical communities. The objective of this research is to understanding theperceptions of the physicians and healthcare professional towards traditional detailing, andexplores the potential values of online communication and electronic detailing ‘e-detailing’.Using the technology acceptance model ‘TAM’ which was developed by Davis (1989),perceived usefulness and perceived ease of use as influential research model are hypothesizedand empirically supported as fundamental determinants of user acceptance of a giveninformation system ‘IS’ and information technology ‘IT’ (Chau, 1996). Alongside thetechnology acceptance model ‘TAM’, the research set out to determine the physicians’ andhealthcare professionals’ attitude and intention to use the internet and related medical web-based technologies as a source of pharmaceutical and clinical information (see figure: 1). Theliterature review provided an overview of the evolution of information technology ‘IT’ andelectronic commerce ‘e-commerce’ in business development. The study is based on theacceptance and the use of the internet technology to explain the physicians and healthcareprofessional computer-usage behavior, and its implication in their clinical practices. For atheoretical development, the research uses a comparative scheme of qualitative andquantitative paradigms (Jones et al, 2005) for assessing the physicians’ and healthcareprofessional’s acceptance status of information technology ‘IT’ in order to validate the 7
  • 8. internet and related web-based technologies as a source of pharmaceutical and clinicalinformation. The researcher uses combined research methods, the qualitative researchmethods via in-depth face-to-face interviews with eight key opinion leaders ‘KOL’ in thehealthcare services ‘HCS’, and quantitative research method via a descriptive questionnaire.Through the process of convenient sampling, the data are captured and collected from asample of 364 physicians and healthcare professionals in the Saudi Arabia. Using standardmethods for analysis the data, the outcome results and the subsequent technologyacceptance model ‘TAM’ variables’ responses of the physicians’ acceptance behavior andattitude revealed itself, and produces a useful measures into the interpersonal factorsinfluencing the internet and related web-based technologies as a source of pharmaceuticaland clinical information. Consistent with Bertrand (2008), the combined results of thetechnology acceptance model ‘TAM’ independent and dependent variables reflect the powerof the internet and medical web-based technology as the most reliable, easily access, and aconvenient source of pharmaceutical and clinical information. The interpretations of thestudy’s findings have concluded that the physicians and healthcare professionals were in apositive trend towards the internet technology as a modern source of pharmaceutical andclinical information. This result is consistent with the study conducted by Joanne (2008) whofurther concluded that “These results will provide a valuable data, with whichpharmaceutical companies may develop, internet-based marketing strategies” (page.4). Thestudy outcomes and recommendations might help a leading pharmaceutical company todevelop online marketing and educational tools to outreach the physicians, the healthcareprofessionals, and the broader medical communities. 8
  • 9. AcknowledgementTo my parents,To whom passed away, in memory of my brother Yasser “You’re not just a memory, youtried your best to teach us before you went away, we now have a better understanding ofwhat you tried to say, please always know we love you and no one can take your place. MayAllah bestow your departed soul eternal peace in Jannah, and grant courage to my family tobear this irreparable loss”To my family, my wife, and my children Moataz, Alaa, Tasneem, and WeaamFor support and toleranceTo Professor Carol Marrow my supervisorFor assistance and advice 9
  • 10. Title“Beyond the Web-Based DTP e- Communication Dashboard: Unleashing the True Value ofPharmaceutical and Clinical Information”DTP: Direct-To-Physician is an advanced online electronic communication and detailing,directly from the pharmaceutical companies to the physicians and healthcare professionals forstrengthening communication, building trust, and maintaining a convenient relationship. 10
  • 11. 1.0:CHAPTER ONE: INTRODUCTIONIn today’s highly competitive healthcare market, pharmaceutical companies face anintimidating set of communication challenges among the physicians and the medicalcommunities. Moreover, many ethical concerns have originated and controversy within boththe medical professionals and the societies (Gibbon, 1998). With the growing competitionand spreading of the financial crises and economy recession around the world, a leadingpharmaceutical company have to come up with a new communication channels to staycompetitive in the global market (Pharma, 2008). An integrated online communication andelectronic detailing ‘e-detailing’ into an electronic customer relationship management ‘e-CRM’ technology (Wang et al, 2002) is an efficient way to establish the physician’s trust,retaining physician’s loyalty, and building long-stay a credible virtual partnership among themedical communities and the societies.1.1 Problem overviewIndeed, a potential costly research and development ‘R&D’, product complexity, shortproduct life-cycle, regulatory requirements, and threats of generic entrance are the majorcommunication challenges that face pharmaceutical companies in the global market.Although branding is one of the communication tools to establish the product in the market(Lim, 2010), the evolution of new innovative pharmaceutical products and establishing theevidence-based medicine ‘EBM’ in clinical practices remains the main challenges that facesthe pharmaceutical companies. At present, the international financial crises and economy 11
  • 12. recession has a significant impact on the sales growth and the profitability of pharmaceuticalcompanies (Buysse et al, 2010). As a consequence, most pharmaceutical companiesannounced restructuring plans, re-prioritization of the strategic internal programs, anddownsizing of the workforce which might range from 3% to 93% (Zhang, 2009).Accordingly, cost control and improve sales growths are the determinant’s factor for thepharmaceutical companies to stay competitive in the global market (Bernwitz, 2001).Therefore, the internet and related medical web-based technologies will provides atremendous way to lower marketing cost, improve sales growth, and maintain interactivetwo-way communication between physicians and healthcare professional. More importantly,managing the relationship between the drug companies and the physicians is becoming thecritical part for building the physician’s trust and maintaining long stay a credible partnershipamong the healthcare professionals (Lim et al, 2010). At present, the in-person traditionalcommunications face many confrontations and many serious concerns have originated.Consequently, the regulatory code of conduct of marketing pharmaceutical products has beenextremely violated (EMEA, 2005). Further to that, the marketing moral and socialresponsibilities which rely heavily on the continuous delivering of accurate and unbiaseddrug information to the physicians and healthcare professionals could be significantlyaffected. This complex relationship may evolve a hidden conflict of interest, and mightcomplicate the traditional ability of the physicians to serve as impartial fiduciary agents totheir patients (Reshma, 2007). 12
  • 13. 1.2 Research rationaleThe world economy recession and the international financial crises significantly enforced aleading pharmaceutical company in putting heightened scrutiny on the economics of theirmarketing and sales strategies (Bernewitz, 2001). Nowadays, the significant changes in thegovernment regulations, regulatory requirements, and the highly dynamic global market willforced the pharmaceutical companies to look at a potential alternative of new business model(Sunil, 2010). In a parallel piece, the globalization and fast speed communication has asignificant impact on the pharmaceuticals’ marketing expenditure, the research anddevelopment ‘R&D’, and leveraging evidence-based medicine ‘EBM’ in the societies.1.2.1 Pharmaceutical’s marketing expenditureDespite the evolution of the promotional ads and fast speed customer outreach,pharmaceutical companies increasingly rely on the traditional detailing and face-to-facepromotion to contact the physicians and healthcare professionals. A promotional campaign isan integral part of the marketing expenditure (Buckley, 2004), representing an essential partin establishing the brand products and for gathering market feedback necessarily for futurestrategies. To extend the brand values, a leading pharmaceutical company spent heavily onthe key opinion leaders ‘KOL’ (Lim, 2010), which can take a variety of forms such asoffering a free medical samples, sponsoring of medical symposium and conferences, andcontributing in the continuous medical education ‘CME’ programs. Buckley (2004) hascomments that “Physician- targeted promotional budget is significantly greater on all 13
  • 14. fronts; both financially and in terms of the eventual outcome make up quarter to third of theirannual budget” (page 6). In a parallel piece, Sorrell (2010) released a report showed themarketing expenditure of the top five companies with the highest expenditures in the USthrough the period FY07- FY09 (see figure: 2), and has concluded that “The majority ofmarketing expenditures outgoing to physicians representing 68%, whereas the prescribedand the healthcare providers occupied 11% and 10% respectively” (page 2). As aconsequence, the traditional face-to-face promotional budget significantly hardens the totalpharmaceutical market expenditure. Currently, the spreading of the financial crisis andeconomy recession around the world enforced a leading pharmaceutical company torestructure the marketing and sales strategies to save profits and maintain its reputation andcompetitiveness around the world. Zhang (2009) has stated that “Many major pharma andBiotech companies have been vigorously strengthening their capabilities and paying moreattention to efficiency, cost-effectiveness, and productivity” (page 1).1.2.2 Research and development ‘R&D’Research and development ‘R&D’ remains the core competence of the companies’competitive advantages tools. A leading pharmaceutical company aims to publicize theclinical trials ‘CT’ results of all adequately designed and well-controlled clinical studies,regardless of the clinical outcome to assess the medical importance of the result from allother clinical studies of marketed medicines (J&JPRD, 2010). A part of their obligation to thephysicians and the medical communities, a leading pharmaceutical company efficiently uses 14
  • 15. the internet and related medical web-based technologies to make well-informed assessmentsabout their products, caregivers must have access to comprehensive and accurate informationthat is also balanced and timely (J&JPRD, 2010). Further to that, meeting the physician’s andclinician’s expectations in their daily clinical practices would enhance in establishing thequality of healthcare services delivered to the patients and the societies. Accordingly thepatients and health care providers can benefit from knowing about clinical studies that areopen for enrollment and the results of studies from the marketed products. Johnson &Johnson research and development (J&JPRD, 2010), recognizes that the transparency andinformation accuracy about their products and investigation drugs is easily accessible, andthey publicly register clinical studies who are open for enrollment and report the results ofclinical trials on marketed medicines to the National Library of Medicine’s website, this siteoffers up-to-date information on federally and privately supported clinical trials for a widerange of diseases and conditions (J&JPRD, 2010). As part of the US regulatory approvalprocess, Pfizer Company listed a post marketing commitment ‘PMC’www.pfizer.com/research/pmc, on the Food and Drug Administration ‘FDA’ website, tosupport the clinical use of the drugs and the continuous monitoring of safety. Accordingly inthe coming years, the internet and related web-based technologies will offer a potentialcommunication tool to conduct online market research, retrieve the necessarily medical andclinical information, and minimize a potential costly research and development ‘R&D’programs. 15
  • 16. 1.2.3 Leveraging evidence-based medicine ‘EBM’Evidence-based medicine ‘EBM’ is the integration of the physician’s clinical expertise andhealthcare professional’s knowledge with the best available clinical evidence from systematicresearch (Hassig, 1999). Obviously, the lack of enough updated clinical and pharmaceuticalinformation eventually led the physicians and healthcare professionals to take decisionsconcerning the medical management of their patients based on their clinical experiences(Eddy, 2005). Evidence-based medicine ‘EBM’ is rapidly evolving, and its practice requiresaccess to clinical evidence and a change in the way medical decisions are made (Lisa, 2007).As described by Mayer (2010), evidence-based medicine ‘EBM’ electronic searchencompasses four broad domains: First, asking answerable questions where the cliniciansshould be familiar with the proper answerable questions and make sure the question containsfour areas abbreviated by acronym “PICO” (Akobeng, 2008). ‘P’ stands for the description ofpatient or population; ‘I’ stand for the intervention, ‘C’ stands for the comparison group, and‘O’ stands for the outcome. Second, an electronic-based search is the easiest and fastest wayto obtain the ready-made clinical evidence available 24/7. For instance, an electronic medicalbooks and magazine such as the Journal of American College of Cardiology (JACC, 2011),the New England Journal of Medicine (NEJM, 2011), the Lancet (2001), and clinicalevidence websites such as Infopoems www.essentialevidenceplus.com, and Up to Datewww.uptodate.com (see figure: 3). Third, applying the evidence to individual patient careas the primary aims of this aspect are to minimize the medical and treatment errors and toassure to a greater degree a better clinical outcome. Forth, evaluating the process through aperiodic review of the content will show how well a clinical question has been answered and 16
  • 17. advise either in the same or another setting. The evolution of information technology ‘IT’allows easily flow of the medical and clinical information, necessarily to help the cliniciansin making the right clinical decision about individual care. McClellan (2008) have pointedout that “The technological and scientific innovation continued to expand the universe ofmedical interventions, treatments, and approaches to care, ushering in an era rich withpotential for improving the quality of healthcare” (page 6). Moreover, patients become moreknowledgeable about their medical condition, and they request for the best medicalinterventions and/or treatments. The internet and related medical web-based technologiesoffer a novel communication tools, to easily access and updates the clinical andpharmaceutical knowledge.1.3 Research objectiveThe primary objective of this research aims to investigate the current relationship between thepharmaceutical companies and the physicians and healthcare professionals, and explores theonline communication and electronic detailing ‘e-detailing’ as a potential alternative ofmarketing and communication channels. A fully integrated information technology ‘IT’ andelectronic commerce ‘e-commerce’ (Liou et al, 2002), will provide a leading pharmaceuticalcompany with a tremendous tool for building the physicians’ trust, and maintaining aconvenient relationship among the healthcare professionals and the broader medicalcommunities. The primary relevance for computer accepting behavior as stated by Davis(1989) is the perceived usefulness and perceived ease of use, whereas the attitude and 17
  • 18. behavioral intention are the secondary one. Therefore, using the technology acceptancemodel ‘TAM’ the research addresses four variables categorized in two aspects, theindependent variables including the usefulness and ease of use the internet technologies, andthe dependent variables including the attitudes and behavioural intention of the physiciansand healthcare professional toward the internet and related web-based technologies as asource of pharmaceutical and clinical information.I) Perceived usefulnessPerceived usefulness is the main determinant user of the internet and related web-basedtechnologies (Yi, 2006), and is considered as dependent and independent variables, and isstrongly linked to outcome expectations. Slatten (2010) has highlighted that “perceivedusefulness is the degree to which a person believes that using a particular system wouldenhance his or her job performance” (page 5). Perceived usefulness is strongly linked to thestudy’s outcome.II) Perceived ease of usePerceived ease of use is the degree to which a person believes that using a particular systemwould be free of physical and mental effort (Slatten, 2010). In respect to present research,perceived ease of use variable has either a direct effect on the physicians’ behaviouralintention to use the internet technology, or indirect effect via their perceived usefulness of theinternet technology as a source of pharmaceutical means. In essence, it reflects that using the 18
  • 19. internet technology perceived to be easier, faster, and reliable as a source of pharmaceuticaland clinical information than the traditional detailing.III) AttitudeAttitude is an individual’s desirability to use the systems (Gardner et al, 2004), and is ameasure of the individual feeling toward using specific system. This provided a hypotheticalexplanation of the physicians’ attitude and intention to use the internet technology in theirclinical practices. Using a comparative method of analysis, the study aims to determine therelationship between the physician’s attitude and their intention to use the internet technologyas a source of pharmaceutical and clinical information in their clinical practices.IV) Behavioural intentionBehavioural intention to use the internet technology as a source of pharmaceutical means,has a positive correlation to the perceived usage of the internet technology (Gardner et al,2004). Behavioural intention measures the strength of physicians’ and healthcare professionalto use the internet and related technology as a source of pharmaceutical and clinicalinformation in their clinical practices.1.4 Research questionsThe questions arise from this research are: 19
  • 20. Is the traditional model of detailing still the best approach?Can electronic communication replace the in-person traditional communication? And how dowe balance the mix of in-person and e-detailing along the product’s life-cycle?How will we integrate valuable physician feedback and information gleaned from eachelectronic communication channel?How electronic communications and e-detailing attain long-term credibility and trust?What are the future expectations of e-detailing as a marketing channel?1.5 Research topicsChapter one stated the significance of the problem, the research rationale, and the researchobjectives and how it will contribute to the healthcare practices. The contextualization of thestudy and provided an introduction to its basic components. Chapter two situated review ofthe literature with relevant themes or variables, and outlined the conceptual framework of thestudy. Chapter three described in details the research design and the research methodology,with an introduction to its basic component. Chapter four organized and reported the studymain results and findings. The study uses a comparative method of analysis and descriptivestatistics of the technology acceptance model ‘TAM’ variables’ responses, the findingsincluding both the qualitative and quantitative results from the research problems andresearch questions. Chapter five interprets and discusses the results and findings in lights ofthe study’s questions. As a result the conclusions for policy and practices andrecommendations for specific action plan have been made, while stated the study’slimitations for further improvement. 20
  • 21. 2.0: CHAPTER TWO: LITERATURE REVIEW2.1 The evolution of information technology ‘IT’ and electronic commerce ‘e-commerce’ in business developmentThe adoption of the internet technologies has revolutionized many aspects of societies(Sweet, 2009), and created rich online businesses media. As a result it brought a newmarketing opportunity. Conceivably, the internet and medical web-based technologies willenable a direct communication between the pharmaceutical company and the physicians andhealthcare professionals. More importantly, it allows direct-to-physicians ‘DTP’ interactivecampaigns.2.1.1 The role of information technology ‘IT’ in business developmentNowadays, the internet and information technology ‘IT’ becomes an integral part of businessdevelopment (Porter, 2001), and play a major role in enhancing the internal communicationand the work productivity within the organizational departments through storing,manipulating, and processing of order information (Davenport et al, 1990). On the otherhand, organizations are using information technology ‘IT’ to overcome the geographicalboundaries and lessen time and effort to outreach the clients and customers 24/7 (Carpano etal, 1998). In today’s highly competitive market, computer-based information technologies‘IT’ may be the primary strategic resource for maintaining competitive advantage (Sabherwalet al, 1991). As summarized by Intel Corp. (2000), the major success factors of informationtechnology ‘IT’ in pharmaceutical business are: 21
  • 22.  Information technology ‘IT’ fully integrated into the company’s overall strategy. Current electronic commerce ‘e-commerce’ systems expanded to cover entire supply chain. Quick time to market-entry to gain first mover advantages, and quick time to market- withdraw to save the company’s reputation and minimizing the late withdrawal cost Healthcare providers and medical society’s expectations well-managed. Website of high qualities that meet physicians’ and clinician’s expectations Monitoring market shares. 2.1.2 Evolution of electronic commerce ‘e-Commerce’ The evolution of information technology ‘IT’ and increasing the number of internet users, makes significant changes to the modes of business communication and commenced the era of electronic commerce ‘e-commerce’ (Alt, 2003). Pharmaceutical companies use its core capabilities by means of e-commerce to improve the efficiency and productivity for clinical development, channel management, and for marketing and sales strategies (Pathak, 2010). To pursue these strategies, pharmaceutical companies utilize and expanded all platforms of e- communication channels. Rama (2004) has stated that “The pharmaceutical industry achieves significant tasks by utilizing e-commerce to circulate information in order to build an integrated network for both the industry and the users” (page 99). Leveraging the customer relationship management ‘CRM’ technologies enable an interactive two-way communication 22
  • 23. (Richard, 2008) among the stakeholders, the key opinion leaders ‘KOL’, and the physicians.With the growing competition, e-commerce enables pharmaceutical companies to create ahigh speed e-communication to interact with the physicians, the suppliers, and otherintermediaries. For instance, this is evidenced by 30% yearly growth increases in the onlineretail business (Kotler et al, 2008). More importantly, the number of the healthcareorganizations and medical suppliers who visited the web page looking for fast speed andinformative business transaction is increased. Most pharmaceutical companies realize thenecessity of conducting business-to- business ‘B2B’, and business-to-customer ‘B2C’ models(Porter, 2001). These online business transaction models are becoming the crucial tools forgaining competitive advantage in the global market. Therefore, a world leadingpharmaceutical companies such as Pfizer, Sanofi Aventis, Glaxo Smith Kline ‘GSK’, Bristol-Myers, Novartis, and Eli Lilly designed and developed websites for launching the innovativeproducts, increasing the sales volume, and reducing the marketing cost.2.1.3 E-detailing diverse platformsTraditional face-to-face drug promotion is the dominant marketing tool (Bernewitz, 2001),where the company’s marketing strategies rely heavily on it to outreach the physicians andhealthcare professionals. Nowadays, pharmaceutical companies face major limitations tokeep the existent key opinion leaders ‘KOL’ and maintained a credible partnership among theothers. The internet and related web-based technologies can greatly expand a companysreach (Heutschi et al, 2003), by providing a newer electronic communication channel throughdiversified e-detailing platforms such as videoconferencing, electronic education modules, 23
  • 24. and the use of email and related technologies to promote two-way communications (Sweet,2009). Videoconferencing is the easiest and the most popular technology of knowledgetransfer via complex traditional and e-detailing (Heutschi et al, 2003). For instance,iPhysicianNet www.localhealthcompass.com a world leader videoconferencing provider,operates e-detailing sessions among others pharmaceutical companies and grant thephysicians with a portable computer ‘PC’ plus internet connection free of charge. Lathianwww.lathian.com a virtual training provider, allows training for specific pharmaceuticalproducts and services, Heutschi (2003) described this form is quietly suitable for conductingonline continuous medical education ‘CME’ program. In practice, a global leadingpharmaceutical company is increasingly turning to e-detailing for marketing their productsand services (Jung et al, 2002) among the physicians, and for building long stay a crediblepartnership among the broader medical communities and the societies.2.1.4 Web-based media partnerTo maintain its reputation as a source of accurate pharmaceutical and clinical information, aleading pharmaceutical company upgrades their partnership with the online marketing mediainto strategic alliance (Kaplan et al, 2010). More importantly, eliciting the physician’sfeedback throughout 24/7 is necessarily for evaluating the company’s current status, andessential for future strategies. From the company’s perspective, maximizing the values-profits ratio fall within synergistic offline-online strategic marketing interactions, whichwould provide opportunities for gains in productivity and meet the physicians’ and healthcare 24
  • 25. professionals’ expectations. For instance, a professional website ExL Pharmawww.exlpharma.com a division of ExL Events Inc. is an industry leader in developinginnovative and educational conferences, that serves the pharmaceutical companies andassociated healthcare communities in the US and Europe. Appature Inc.www.ignitionpartner.com is another Exl Events Inc. group www.exlpharma.com, whichprovides simple website marketing solutions designed exclusively for healthcare companies,to quickly gain new customer insights and create programs to deepen brand awareness anddrive greater sales growth (ignition, 2011). Below is a list of a useful web-based mediapartner: Online media partner Network site Cadient Group http://www.cadient.com Lathian Health http://www.lathian.com The Little Blue Book http://www.t1bb.com Physicians Interactive http://www.phyisiansinteractive.com Within 3 http://www.within3.com Siren Interactive http://www.sireninteractive.com Imc2 Health & Wellness http://www.imc2healthandwellness.com2.2 Potential benefits and main challenges of electronic detailing ‘e-detailing’In synergy ways, e-detailing augment the traditional detailing (Heutschi et al, 2003), whichwill help the pharmaceutical companies to staying in credible, legitimating ethics, buildingtrust, and maintaining a convenient relationship into the physicians, the stakeholders, and the 25
  • 26. broader medical communities . The potential benefits of e-detailing in the pharmaceutical business from the company’s and physician’s perspectives are summarized in the following: 2.2.1Company’s perspectives To maintain its reputation, a global leading pharmaceutical company capitalizes on the online communication and the internet technologies to attain the following: Enriches the profits-values ratio through lower detail cost and greater physicians reach 24/7. As reported by the Fact Sheet (2005) traditional detailing is the second largest market segment of $6.78 billion representing 22% of the total market expenditure. Moreover, a report released by Fact Sheet on (2007) has estimated that the approximate cost of face-to- face sales interaction is high relative to the time consumed. The combine offline-online detailing has a positive marketing effect (Manhattan Research, 2008). The ease of accessibility and the content of medical and clinical knowledge via online communication and e-detailing, enable for eliciting the physician’s feedback for future marketing and sales strategies. Development of e-customer relationship management ‘CRM’ technology (Alt, 2003) would provide an easy, fast, and a convenient way to improve the efficiency and productivity of the business around the world. Online communication and e-detailing allows marketers to better segmenting the market potential especially prior the market orientation (Curry et al, 2000). 26
  • 27. A unified view of e-detailing would provide significant benefits through leveraging efficient customer relationship management ‘CRM’ technology, optimizing product life- cycle management ‘p-LCM’, branding, and pharmacovigilance technology alerts. 2.2.2 Customer relationship management ‘CRM’ technologies In today’s business, consolidating the value-profit ratio among the key opinion leaders ‘KOL’, the physicians, and the medical suppliers is essential to maintain competitive in the global market. Although customer retention strategy is essential to keep the valuable customers (Sasser, 1990), customer acquisition strategy is the critical success factor ‘CSF’ to capture a newer customers for a long-stay business relationship. Therefore, reducing the marketing cost and increasing the sales revenue derived from serving customer is a meant of customer relationship management ‘CRM’ technologies strategies and implementation. The customer relationship management ‘CRM’ technology provides the pharmaceutical companies with a mechanism for segmenting its customer base, and to visualize and analyze customer’s behavior, loyalty, and value within each of those customer segments (Curry et al, 2000). Moreover, the internet-based electronic customer relationship management ‘CRM’ is a collaborative technology for efficient communication and sharing information between the pharmaceutical companies and the healthcare professionals (Sweet, 2009). These technologies tools efficiently facilitate the following: Real-time communications access throughout 24/7. 27
  • 28.  Highly professional web content with respect to the physicians’ interests. Highly integrated -intranet system for information management allows companies to increase collaboration among corporate employees, business partners, and suppliers (Berkowitz, 2010). An electronic customer relationship management ‘e-CRM’ technology aims to maximize the lifetime customer’s values, through efficient integration of the traditional sales force and the internet-based communication (Alt, 2003). Thereby, this will help pharmaceutical companies in better segmenting the market based on the customer services such as the key opinion leaders ‘KOL’ (Lerer, 2002), understanding the epidemic status of the diseases area, and the recommended duration of treatment. An example of global technology and service company specialized in the healthcare field is Cegedim Relationship Management www.cegedim.com a life sciences industry’s leading provider. Cegedim supplies services, technological tools, specialized software, and data flow management services in the healthcare business. 2.2.3 Product life-cycle management ‘p-LCM’ In the modern global economy, pharmaceutical companies are facing time-to-time challenges; time to enter the market early to gain the first-mover advantages, and time for short-term profit return (Chataway et al, 2008). Product life-cycle management ‘p-LCM’ is recognized as one of the keys leading technologies to facilitate the companies to overcome these challenges (Ming et al, 2005). As the cost of developing new innovative drugs 28
  • 29. continues to escalate, a leading pharmaceutical company is working to improve research and development ‘R&D’ programs, shorten the production phases, and establishing the brand in the market. The core values of product life-cycle management ‘p-LCM’ are information and time (Oracle, 2008). Therefore, timely management of the information assets can influence the timely market-entry to capture the first-mover advantages in the class- therapeutics, shorten time-to profit, and allows a larger post marketing clinical trials for brand extension and expansion. Accordingly, product life-cycle management ‘p-LCM’ technology is the one of the most rapidly growing technologies in the pharmaceutical market industry, and its implementation can help improve the information challenges associated with the product management (Datamonitor, 2007). The holistic approach of the product life-cycle management ‘p-LCM’ is characterized by the following: Improving the visibility of the product information and utilization among the healthcare organizations and medical suppliers. Product life-cycle management ‘p-LCM’ offer a long-term brand protection, as well as short- term recovery following risen claim of unexpected adverse drug reaction ‘UADR’ related to the brand, the unethical marketing, and losing of the drug discovery data (Katz, 2010). Allows time-reduction through electronic submission compilation, and timely- response to data request mandated by government regulations and other authorized corporate governance (Katz, 2010). Provides a wider scope of what information needs to be reviewed and protected within the specified time-frame 29
  • 30. An efficient implementation of the product life-cycle management ‘p-LCM’ technology willhelp a leading pharmaceutical company to develop a new drug faster, more safely, and atlower cost (Oracle, 2008).2.2.4 BrandingBranding of pharmaceutical products is complicated by the short product life-cycles and theregulatory authorities on communication the basic benefits of the drug (Lim et al, 2010).Although the major mass of communication channels are through the medical journals,conferences and symposia, continuous medical education ‘CME’ programs, and hospitaleducational forums, branding in the pharmaceutical industry is seen as an important aspect ofcommunication (Lim et al, 2010). At present, the role of the key opinion leaders ‘KOL’ arequite obvious not only during the launching phase of the products but, also to simplify anddelivers the brand’s messages and emphasize the brand’s benefits versus the competitors inthe medical communities. As consequences, pharmaceutical companies rely heavily on therole of the key opinion leaders ‘KOL’ to augment the brand’s communication mix in theclinical practices, and strengthening the brand values in the medical communities (Lim et al,2010). Further to that the clinicians respond to the new clinical interventions by seekinginformation and opinions from peers and opinion leaders, rather than assessing the scientificmerits by themselves (Peter et al, 2004). Moreover , a relatively inexpensive generic drug isthe major threats that hit brand shortly beyond market-entry, Lofgren (2002) has stated that“Public and private third-party payers increasingly encourage or mandate the use of 30
  • 31. generics through measures such as generic prescribing and generic substitution” (page1). Inthis regard, a leading pharmaceutical company can develop an electronic brand hand-leddevices such as, electronic brand-connect ‘eb-CONNECT’ loaded with pharmaceutical andclinical information necessarily to help the physicians and clinician to make the properclinical judgment for a better clinical care. Therefore, following a successive product-lifecycle management ‘p-LCM’ programs, the electronic communication and the diversified e-detailing platforms will offer a broader communication channels to establish the brand amongthe physicians, the medical communities, and the societies 24/7.2.2.5 Online disease awarenessA part of their continuous medical education ‘CME’ and social responsibility, a globalleading pharmaceutical company increasingly uses e-detailing for disease awarenesscampaigns. Sweet (2009) has pointed out that “Pharmaceutical companies are capitalizing onthe advent of the internet and the development of new media forms to promote their products”(page 2). Among the tools being used are interactive websites, email prompts, and viralmarketing campaigns using social networking sites (Bampo et al, 2008) such as; YouTubewww.youtube.com, MySpace www.myspace.com, Twitter www.twitter.com, and Facebookwww.facebook.com. Such campaigns are targeting the physicians, the healthcareprofessionals, and the general public. For instance, pfizer reportedly collaborating withSermo Inc. www.sermo.com a web venture based in Cambridge the US, where tens ofthousands of doctors discuss diagnostic and treatment issues in anonymous postings, thiscollaboration allows pfizers doctors to ask questions and respond to post (Johnson (2007) . 31
  • 32. Members can also rank postings, which will give insights likely to help the companysdevelopment of marketing messages. Sweet (2009) has reported that Sermo rewards thephysicians whose input is highly ranked by other members. As a part of social responsibilitiesand building partnership with the patients and medical communities, Bayer Schering Pharmaconducted Thrombosis Advisor a web-site information resource www.thrombosisadviser.comfor the physicians and patients about thrombosis. GlaxoSmithKline ‘GSK’ on its corporateblog in the US; http://alliconnect.com allows conversation for the healthy weight lossproducts, such active conversation enables GSK eliciting the necessarily feedback for futuremarketing strategies.2.2.6 Pharmacovigilance alertThroughout the product life-cycle period, a leading pharmaceutical company faces with agreater regulatory requirements and increased accountability demands for the protection andwelfare of patients (ICPM, 2008). Moving beyond the standard regulatory requirements,pharmacovigilance technology can assist pharmaceutical companies to systematically detectand prevent the adverse drug reactions ‘ADR’ (Lu, 2009), and preventing the costly safety-related market withdrawal. Now a day, information technology ‘IT’ has transformed thetraditional healthcare system and clinical medicine into higher quality and with lower cost(Lu, 2009). In this regard, the post marketing surveillance, the safety data collection in reallife clinical practices, and clinical risk assessment are critical for evaluating and managingthe safety and risk profile (Lu, 2009). 32
  • 33. 2.2.7 Social network sitesRealizing the power of the social networking sites, a global leading pharmaceutical companycapitalizes on the social networking platforms (Stockman, 2010) such as, Twitterwww.twiter.com , Blog www.blog.com , Facebook www.facebook , Linkedinwww.linkedin.com , and other social media account for the news, announcements, anddelivering medical and pharmaceutical information (Sweet, 2009). For instance, Pfizeraddressed its mission on the Facebook page; www.facebook.com/pfizer as “Good health isvital for all of us. We strive to provide access to safe, effective and affordable medicines andrelated health care services to the people who need them” (page 2). A part of the socialresponsibilities and for building trust and long stay credibility among the societies andpatients as well, pharmaceutical companies capitalizes on the social networking media todisseminate their values and visions to create a virtually-loyal customer.2.2.8 Physician’s and healthcare’s perspectivesA survey conducted by Google (2009) demonstrated that 65% of the physicians access theinternet more than once per day, where 86% of them have used the internet to gather clinical,medical, and prescription drug information. In particular, the reasons for use of the internetand related medical web-based technologies were felt primarily in the Physician’s acceptancebehavior. An e-detailing solution gives the physicians and healthcare professional greatercontrol over the time, the place, and the content as well as the quality of the information(Accela, 2009), and provides a convenient direct-to-physicians ‘DTP’ electronic 33
  • 34. communication throughout 24/7. Undoubtedly, the quality and the quantity of the informationcontent delivered by e-detailing reinforce the physicians and healthcare professionals tofrequently update their medical knowledge as a part of the continuing medical education‘CME’ programs. On the other hand, the critical success factors ‘CSF’ of e-detailing is theaccessibility throughout 24/7 and fast speed on retrieving the needed pharmaceutical andclinical information. For instance, GlaxoSmithKline ‘GSK’ a leading healthcare companydeveloped GSK source website www.gsksource.com , which permits an easy access to becomprehensive, to update information, and navigate clinical information and services. SanofiAventis, a world leading pharmaceutical company conducted The Partnership forPrescription Assistance a web-site in US www.sanofi-aventis.us/live, the program isdesigned to join Americas pharmaceutical companies, the doctors, the patient advocacyorganizations, and the community groups to help qualify patients who lack prescriptioncoverage get the medicines they need through the public or private program thats right forthem. Generally through the diversified e- detailing platforms, a leading pharmaceuticalcompany efficiently establishes an interactive two-way communication for deliveringaccurate and updated pharmaceutical and clinical information in a fast and flexible way.Consequently, this allows the companies to access easily the physician’s feedback necessarilyto design an efficient customer relationship management ‘CRM’ strategy, for building trustand maintaining a convenient relationship into the stakeholder’s and the physicians’. 34
  • 35. 2.2.9 Main challenges of information technology ‘IT’ and e-detailing Although many e-detailing approaches were in the experimental stages, the observer could find that e-detailing confronted with a series of challenges. These challenges can be summarized as follows: In the near future online activities run alongside the offline communication rather than substitute it. Therefore, e-detailing approaches may burden the company’s marketing expenditure (Heutschi et al, 2003). The healthcare market structure and the scope of achieving the economies of e-detailing is limited in various regions, as the e-detailing providers’ solution were concentrated primarily in homogeneous healthcare market (Boehm 2002). The internal field force resists the e-detailing approaches which might raise a conflict among the sales representatives and the company’s management and eventually hindering the company’s marketing and sales strategies. Regulatory restrictions, where the company’s payment, sponsoring of conferences and symposia, and incentives to the physicians and healthcare professional must comply with the regulatory code of conduct of promoting medicinal products (EFPIA, 2007). Long time needed to establish a technical information technology ‘IT’ foundation. High subscription cost of the online medical and pharmaceutical websites. 35
  • 36. 3.0: CHAPTER THREE: RESEARCH DESIGNIn many areas of the health care research, the combining qualitative and quantitative methodin a single study is widely practiced and accepted (Sale, 2002). Alicia (2007) has concludedthat “Mixed methods research in healthcare service research ‘HSR’ is common in the UK, itsuse is driven by pragmatism rather than principles, motivated by a perceived deficit ofquantitative method alone to address the complexity of research in healthcare” (page 1)3.1 Mixed methods researchThe complexity of the research problems within the health sciences makes using a mixedmethods research design more appropriate to use (Creswell, 2009). In respect to the presentresearch, the mixed methods are used to uncover a more profound understanding of thephysicians’ perception and attitude towards the internet and related web-based technology asa source of pharmaceutical and clinical information. Combining the qualitative andquantitative method research gives the researcher the opportunity to support the hypothesiswith the evidence, generating a more productive analysis of data, and enables the possibilitiesof new ways of thinking that materialized from the two different types of data (Johnson et al,2007). Similarly, some researchers have argued that the complexities of the most publichealth and social interventions such as health education and health promotion programsrequire the use of a broad spectrum of quantitative and qualitative methods (Steckler et al,1992). The qualitative and quantitative aspect of this research is based on a particularparadigms; the quantitative paradigm is based on positivism where there’s only one truth and 36
  • 37. the researcher is capable of studying the perceptions of the physicians and healthcareprofessionals toward using the internet and related web-based technologies in their clinicalpractices, without influencing it or being influenced by it. The qualitative paradigm is basedon articulate respondent of the key opinion leaders ‘KOL’ in qualitative interviews, becausethey are a leader and have the ability to see the holistic picture (Reid, 1996). The researcherand the object of this research are interactively linked so, that findings are mutually createdwithin the context of the situation which shapes the research hypothesis (Denzin et al, 1994).The survey was conducted in the Saudi Arabia, and has been designed to investigate thestatus of the traditional communication of the pharmaceutical companies among thephysicians, the healthcare professionals, and the broader medical communities and to explorethe potential values of e-detailing and online communication. The prospects survey attemptsto answer the following coordinates; the physician’s and healthcare professional’s attitudestoward traditional face-to-face detailing and e-detailing interactions, their beliefs about theproduct’s information conveyed by the traditional detailing and e-detailing, and the futureexpectations of the online e-detailing.3.1.1 Development of grounded theoryUsing the principles of the grounded theory which was first presented by Glazer and Strauss(1967), the study applied substantive grounded theory to develop a conceptual hypothesis ofthe potential role of the internet and medical web-based technology as a source ofpharmaceutical and clinical information in the healthcare settings. The common features of 37
  • 38. the substantive grounded theory is that it’s carefully induced from the diverse data (Cerniglia, 2008), and it’s closely related the realities of the perception of the physicians and healthcare professionals toward the internet and medical web-based technology as a source of pharmaceutical and clinical information in their daily clinical practices. The substantive grounded theory is not only understandable to the people working in the substantive field but also, sharpens their sensitivity to the research problems (Cerniglia, 2008). Rather, the developed substantive grounded theory transcends and gets applied to any other substantive field regardless of the time, place, and people participated in the study (Glazer, 2002). Through a comparative method of analysis, the substantive grounded theory is inductively derived from the study’s findings, which have been obtained through systematic research methods using the following steps:1. Identify the research problem from the qualitative interviews, and the categories with relevant themes that emerge from the previous studies and the literature review, develop the research questions, and the method used in judging and comparing the results.2. The combined qualitative and quantitative data is collected and coded to provide a conceptual framework of the study (Glazer, 2002).3. The data was analysed and categorised to describe the research hypothesis. The technology acceptance model ‘TAM’ variables’ responses are identified, labelled, and categorised to describing overall features of the research results and findings. 38
  • 39. 3.2 The qualitative method3.2.1 MethodologyUsing standardized open-ended interview technique will help provide a theoreticalexplanation, grounded by the physician’s perception towards the offline and online detailing.Interviewees will be asked identical questions and the questions were worded so, thatresponses are open-ended (Turner, 2010). This type of the questioning technique will help toelicit responses based on the personal experiences and opinions, toward the potential valuesof the internet and related web-based technology as a source of pharmaceutical and clinicalinformation, and allows the researcher to prepare follow-up questions focuses on the researchhypothesis (Turner, 2010).3.2.2 Pilot interviews testPrior to the implementation of the planned interviews, a pilot interviews test has beenconducted with three participants that shared the same interests as those of selectedinterviewees (Turner, 2010). The purposes of the pilot interviews test is to assess theproposed time for the interview , examine the type of questioning technique and the questionsflow , and allow for refinement of the research questions (Turner, 2010). 39
  • 40. 3.2.3 Sample selectionUsing a convenient sampling, eight interviewees were selected based on the criterion-basedsampling that they will be willing to openly and honestly share information and provides themost credible information to the study (Turner, 2010). Interviewees were carefully selected tounderstand their perceptions towards using the internet and related web-based technologies asa source of pharmaceutical and clinical information in a permissive and non-threateningenvironment (Ogunbamerm 2003). The choice of the interviewee was based primarily on thebasis of accessibility and willingness to participate, and was conveniently selected from theaccessible physicians and healthcare professionals. Accordingly, eight participants wereselected from the healthcare authorities; the Saudi Food and Drug Authority ‘S-FDA’, thepharmacy directorates, and the physicians and healthcare professionals in the academic andgovernmental hospitals. Interviewees were asked identical unstructured questions in terms ofwording, so that the responses are open-ended (Gall et al, 2003). The researcher aims throughthis interview design to allow the participants to contribute as much detailed information asthey desire, to fully express their viewpoints and experiences, and it also allows theresearcher to ask probing questions as a means of follow-up (Turner, 2010). The selectedinterviewees have the necessarily skills such as, key opinion leader ‘KOL’, having visionsand values, and have the ability to see the holistic pictures (Boyce et al, 2006).3.2.4 Preparation of interviewIn order to provide maximum benefits to the research hypothesis, the researcher applies fourprinciples to the preparation stage of interviewing (Turner, 2010) which includes the 40
  • 41. following ingredients: (1) explain the purpose of the interview (2) address terms ofconfidentiality (3) explain the format of the interview (4) indicate how long the interviewusually takes. The sample population for these interviews will be managing the drugregulatory in Saudi Food and Drug Authority ‘S-FDA’, key opinion leaders ‘KOL’ inhealthcare services, and consultants physicians and general practitioner3.2.5 Ethical issues, privacy and confidentiality of research participantsAlthough there is no agreed guideline for judging the ethics of qualitative research (Richardet al, 2002), the researcher realizes the necessity of the ethical issues which arise whenplanning and carrying out this qualitative interviews with the physicians and healthcareprofessionals. The researcher recognizes the four potential risks to the research participantsthe anxiety and distress, the exploitation, the misrepresentation, and the identification of theparticipants in the published paper (Richards et al, 2002) details in section 3.3.4 and 3.3.5.3.2.6 Data CollectionThe data has been collected between June and August, 2010. The conducted interviews wereface-to-face at a time and place convenient for the interviewee. Average duration of theinterview was thirty minutes. The interviews were documented by written description andtranscribed by the researcher. 41
  • 42. 3.2.7 Reliability and ValidityAssessing the internal reliability and validity of the present research is crucial to ensureaccuracy of the data. Pope (2002) has stated that “Qualitative methods are often seen asscoring highly in terms of internal validity” (page 150). Therefore, the study design and themethod of analysis used are quietly suitable for the aid of the research objective in a giventime. However, the study is unlikely to be replicated under the same controlled conditions(Pope, 2002).3.2.8 Data Analysis and presentationAs in the grounded theory methodology, the qualitative and quantitative data is collected andreferred to as coding (Creswell, 2007). The detailed procedures for the data analysis consistof three stages first, open coding is an initial stage in the data acquisition through which thedata is selected, and the open coding categories which is extensively discussed by theresearch participants is identified and listed as the central phenomenon for the purposes of theresearch questions (Creswell, 2007). Further to that the technology acceptance model ‘TAM’variables’ responses are labeled and categorized to describe the overall features of theresearch hypothesis. Second, axial coding through which the selected categories and thetechnology acceptance model ‘TAM’ variables’ responses are interconnected to each other’s,to form the coding paradigm (Creswell, 2007), which provided insight into specific codingcategories that explain the central phenomenon and built the theoretical model of the study(Creswell, 2007). Third, selective coding where the core categories in the coding paradigm 42
  • 43. are selected and interrelated to generates conceptual statement that hypothesizes the theoretical model of the study (Creswell, 2007). 3.3 The quantitative method 3.3.1 Methodology The survey was conducted in a questionnaire format comprising twenty items within four categories (see figure: 4), each of which has series of questions and each question provide six answers ranging from ‘strongly agree’ to ‘strongly disagree’ from which the respondent could choose (see section 3.4.2). The responses were scored numerically and then quantified, categorized, and subjected to statistical analysis using computer excel program. The descriptive questionnaire items are characterized by: The questionnaire deals with a specific situation, that requires visibility of the observational techniques used for the data collection The physicians and the participants for the research were carefully selected and clearly defined Particular attention has been given to safeguard the collected data from the influence of bias (Powell, 2004). Data must be collected, organized, and presented systemically so that valid and accurate conclusion may be drawn (Allers, 2010). The researcher used a Likert Scale (Trochim, 2006), where the collected information has been grouped into six categories with boxes to tick. The “Don’t know” box is there, in order 43
  • 44. to forestall a common analysis error, which is to assume that the middle box representssomething in between the two extremes, whereas a respondent who wants to indicate noopinion ticks it as if it were neutral. The twenty items were arranged in a logical way to findout the determinants of the technology acceptance model ‘TAM’ variable’s scores necessarilyto reach the research objective.3.3.2 Questionnaire testingA pilot test has been carried out after completion of the questionnaire format (Turner, 2010),to examine the questionnaire structure, the flow of the questionnaire items, and the level ofunderstanding the questions (see figure: 5). The responders were asked verbally about theirunderstanding, the time needed to fulfill the questionnaire items, and the ease or difficultiesof answering the questions.3.3.3 Sample selectionA careful sample selection has been carried out to investigate the research hypothesis, and todraw a general conclusion about the physician’s perception toward the online communicationand e-detailing (Limpanitgul, 2009). Accordingly, the present research follows a five stepprocedures from defining the target population to collect the data from the sample(Limpanitgul, 2009). The sample size of the research was drawn from the Ministry of Health‘MOH’ directorate database of 364 physicians and healthcare professionals. The survey wasfollowed a non-probability sampling procedure (Trochim, 2006), and has been carried outwithin the period from 10th of July 2010 to 5th of August 2 44
  • 45. 3.3.4 Ethical issues of the research participantsTo date, the reservations held about strict ethical guidelines for the health service research‘HSR’ plays a major role in adoption of agreed standard of good practice (Richards et al,2002). Whilst recognizing the main ethical issues rose on carrying out this research, theresearcher aims to minimize the potential risks and the consequences of legislative change inhuman rights and data protection of the research participants. As mentioned by Richard andSchwartz (2002) the four potential risks of the research participants who might be observedwere: Firstly, anxiety and distress the researcher aims to avoid anxiety and distress provokedfrom unpredictable sensitive topics and questions, by designing a research deals with aspecific situation that requires visibility of the observational techniques used for collectingthe data and delivered predictable questions. Secondly, exploitation is an important aspectwhich significantly harms the research, the researcher avoided exploiting the power ofrelationship and the participants from feeling pressurized to participate in research, becausethey depend on the goodwill of their corers (Holloway et al, 1993). Thirdly,misrepresentation recognizing that the participants are more likely to feel that their viewshave been misrepresented and taking out of context, the present research designed to answerspecific questions about their perceptions, attitudes, and behavioral intention towards theinternet and related web-based technologies as a source of pharmaceutical information.Fourthly, the nature of qualitative health service research ‘HSR’ collect a large amount ofparticipants’ information and views. Therefore, identification of the participants in publishedpaper by themselves or others, potentially may lead to serious harm. Accordingly, theresearcher recommended strategies for reducing the risk of harm include ensuring scientific 45
  • 46. soundness, ensuring privacy and confidentiality, and anonymity of the research participants(Richards et al, 2002).3.3.5 Privacy, confidentiality, and anonymity of the research participantsThe identity of the participant in this study appears to have become central to the design andpractice of ethical research (Grinyer, 2009). Thus, the privacy and anonymity of thephysicians and healthcare professionals have been designed within the context of thisresearch, and it was achieved once the data has been collected and not subject to re-construct.Grinyer (2009) further comments that “The research participants should understand how farthey will be afforded anonymity and confidentiality and should be able to reject the use ofdata gathering devices such as tape-recorders and video cameras” (page 50). As a result, theparticipants should be able to recognize themselves, while the reader should not be able toidentify them.3.4 Data collection, data capturing, descriptive statistics, and validity and reliability3.4.1 Data collectionTo harvest high quality data, the questionnaire items were structured and sequenced in a wayto ensure easily flow of the category’s variable answer and to avoid burdening on therespondent’s working memory (Mora, 2011). The questions were designed as closed-ended 46
  • 47. questions with answer choices (CSU, 2011), and were formulated with the right wording so itaccurately reflects the perception of the physicians and healthcare professionals towards theinternet and related web-based technologies as sources of pharmaceutical and clinicalinformation (see figure:6). Data collection involves all activities and processes to obtain datanecessarily to explore a new era of pharmaceutical and clinical information or to confirm theprevious findings, either qualitatively through in-depth face-to-face interviews, orquantitatively by contacting the physicians and healthcare professionals through aquestionnaire.3.4.2 Data capturingTo capture high-quality data, the different parts of the questionnaire’s item work in harmonyand in consistency to avoid responder’s confusion (Mora, 2011). With the guidance ofqualified statisticians the data captured onto an Excel Application Program ‘EAP’, eachquestion and option were numbered uniquely and occupied a single field in the database. Theperceptions are measured on a continuum from one extreme position to the opposite extremeposition. The Likert scale response mechanism (Trochim, 2006) and William (2006) allowfor five responses, namely, ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘stronglyagree’. Numerical values of one to five were allocated to each response in respective order.Numerical values with a value of less than three represent a negative perception to thequestions while, numerical values greater than three reflect a stronger perception. The valuethree offers a neutral response. 47
  • 48. 3.4.3 Descriptive statisticsThe primary goal of the data analysis is to arrange the collected technology acceptance model‘TAM’ variable’s responses in a way that the answer to the research questions reveals itself(Wrenn et al, 2007). Given all the technology acceptance model ‘TAM’ variable’s responses,the resultant substantial large volume of data from this research was carefully condensed andsummarized (Walter, 2009). The use of descriptive statistics (Trochim, 2006) may assist inthe following parameters: First, it indicates the central point around which the questionnairedata distributed. Second, it may show the relationship of one technology acceptance model‘TAM’ variable to another one. The central location statistic represents a middle point of aset of observations and is useful for comparative analysis (Trochim, 2006). The followingmeasures for central location will be used:• The MeanThe mean is the location measure most frequently used for interval-ratio data (Somekh et al,2002). Mathematically, it is the arithmetic average representing the sum of the ascertainedvalues in the distribution divided by the number of observations.• The MedianThe median is the score found at the exact middle of the set of values (Trochim, 2006). Tocompute the median is to list all scores in numerical order where half the scored values willfall below this median value and the other half above it. 48
  • 49. • The ModeThe mode is the most frequently occurring value in the set of scores (Trochim, 2006), and isthe only means of measuring central tendency around the mean containing nominalcategorical values (McCluskey et al, 2007).• The Standard DeviationThe standard deviation ‘SD’ is an important aspect for descriptive statistics because it revealsthe amount of variability of individuals within a data set (Trochim, 2006). The standarddeviation ‘SD’ gives an accurate and detailed estimate of the dispersion and shows therelation of the technology acceptance model ‘TAM’ variable’s scored values has to the meanof sample size. The standard deviation ‘SD’ is the square root of the sum of the squareddeviation from the mean divided by the number of scores minus one and is calculatedaccording to the formula below: SD = Σ (X-X) 2 (N-1)Where:SD is Standard DeviationΣ: Sum of score 49
  • 50. X: each scoreX: The mean or averageN: Number of values• Correlation analysisThe correlation analysis is the statistical tool use in order to measures the linear relationshipbetween questionnaires’ variables and how closely they relate to each other (biddle, 2005),where the value of correlations existed known as a correlation coefficient represented by the(r) symbol. The (r) values ranged from -1.0 to +1.0, the negative values represent a negativerelationship between the questionnaire’s item and the positive values represent positiverelationship between the questionnaire’s items. According to Trochim (2006) the correlationcoefficient (r) was calculated as:Correlation (r) = [NΣXY - (ΣX) (ΣY) / Sqrt ([NΣX2 - (ΣX)2][NΣY2 - (ΣY)2])]where: N = Number of respondents . X = First Score. Y = Second Score. ΣXY = Sum of the first and Second Scores. ΣX = Sum of First Scores. ΣY = Sum of Second Scores. ΣX2 = Sum of square First Scores. ΣY2 = Sum of square Second Scores. 50
  • 51. The probability (p) threshold to be no more than 0.05 or 5%, the level of correlationcoefficient (r) significance is determined at (p) < 0.05 (Trochim, 2006). The (n) represent thetotal number of respondents; the large (n) will lead to be statistically significant (r), whereasthe smaller (n) conversely will lead to statistically non-significant.3.4.4 Validity and reliabilityTo ensure consistency and credibility of the present research, it was necessarily to track thevalidity and reliability standards of quantitative research. As noted by Golafshani (2003) that“Reliability and validity are tools of an essentially positivist epistemology.” (Page.598), thevalidity of the present researcher uses naturalistic approach that seeks to understand, anddetermines whether the research truly measures the perceptions of the physicians andhealthcare professionals toward the internet and medical web-based technologies as a sourceof pharmaceutical and clinical information. The construct validity is the truthful of thestudy’s concept and the drawn conclusions of the study results and findings (Golafshani,2003). On the other hand reliability represents that the measurement are accurate and theresult is consistent overtime and is readily modifiable by comparative analysis with new dataregardless the time, place, and population (Glazer, 2002). Using the collected technologyacceptance model ‘TAM’ variable’s responses, the reliability and validity of the factorscontained in the research was evaluated, and the reliability was assessed using a Pearson’scorrelation coefficient (r). The purpose of Pearson’s correlation coefficient (r) is to measurethe internal consistency and reliability of the scored values and to assess whether there is arelationship between two or more technology acceptance model ‘TAM’ variables (Yaffe, 51
  • 52. 1999). As summarized in the table below, the computed Pearson Product MomentCorrelation coefficient (r) showed that the investigated technology acceptance model ‘TAM’variables exhibited an alpha value (r) greater than 0.5, with an overall result of 0.98,suggesting a high degree of internal consistency. Pearson Product Moment CorrelationStatistic Variable X Variable YMean 287.5 585.2Biased Variance 16008.75 21686.56Biased Standard Deviation 126.6 147.3Covariance 8098Correlation 0.412877948Determination 0.1704682T-Test 1.9P-value(2 sided) 0.07p-value (1 sided 0.03Degree of freedom 18Number of Observation 20For the items relating to perceived usefulness, the Pearson correlation coefficient (r) is + 0.2indicating a moderate degree of internal consistency. For the items relating to perceived easeof use and attitude the Pearson correlation coefficient (r) is +0.9 indicating a high degree ofinternal consistency. For the items relating to behavioural intention the (r) value showed anegative correlation of -0.2 indicating that the technology acceptance model ‘TAM’variable’s scores increase and the other decrease and vice versa. 52
  • 53. 4.0: CHAPTER FOUR: DATA RESULTS, DESCRIPTIVE STATISTICS,AND STUDY FINDINGSRealizing the complexity of the internet and related web-based technology as a source ofpharmaceutical and clinical information in the healthcare practices, the combining qualitativeand quantitative research results maintained favorable views of a new model of onlinecommunication and e-detailing.4.1 The qualitative data resultQualitative interviews would have provided a comparative cross-section of all physicians andhealthcare professionals (Brewster, 2008) and will assist to develop an initial understandingof the physicians’ perception toward traditional detailing and exploring the future role of theinternet and related medical web-based technologies as a source of pharmaceutical andclinical information. The interviews were of an exploratory nature and have been conductedin the participant’s offices, where the physicians and research participants were asked todescribe their experience with the internet technology as a source of pharmaceutical andclinical information and its implication in their daily clinical practices. Each interview wastranscribed by the researcher and then coded. There were several significant findings fromthe interviews that help in designing the questionnaire’s item for the aid of research objective.The two interviewees included; the vice-president for drug affair in the Saudi Food and DrugAuthority ‘S-FDA’ who urged the physicians and healthcare professionals to efficientlyutilize the advanced information technology ‘IT’ infrastructure in Saudi Arabia, to frequently 53
  • 54. updates their medical knowledge and improve their professionalism in the healthcare settingthat helped in establishing the evidence-based medicine ‘EBM’ principles in the communityand he has comments that “With the internet and adoption of a new web-based medicaltechnology, there’s no excuse for the physicians and healthcare professionals to update theirknowledge about pharmaceutical products, and following the international guideline formanaging the diseases”. Additionally, he criticized the relationship pattern between thepharmaceutical companies and the physicians so, further he has noted that “The Saudi Foodand Drug Authorities ‘S-FDA’ warns the unethical concern arisen from the relationshipbetween pharmaceutical companies and the physicians and healthcare professionals.Therefore, in compliance with the international code of conduct, they develop a local code ofconduct for marketing of pharmaceutical and medicinal products in Saudi Arabia”. Whereasthe Public relation affair manager in the Saudi Food and Drug Authorities ‘S-FDA’emphasize the role of the internet and medical web-based technology as a source ofpharmaceutical and clinical information and so, he has stated that “The internet and relatedweb-based technology offer a valuable tool for the physicians and healthcare professional toupdate their knowledge about the disease area, pharmaceutical product, and managementespecially in scattered regions like Saudi Arabia, but the only limitation might be the lack ofinternet access in some areas”. Both interviewees shared the common idea whilst, theyemphasize the added-values of the internet and medical web-based technologies onestablishing the evidence-based medicine ‘EBM’ in the society, they are in agreement thatthe adoption of internet technologies in the healthcare system help significantly inminimizing the frequency of the medical and treatment errors. Additionally, they realize the 54
  • 55. necessity of regulatory requirements of the pharmaceutical products and the growing need fora better patient’s care and safety. Accordingly, the Saudi Food and Drug Authorities ‘S-FDA’designed a technology-based National Drug & Poison Information Center ‘NDPIC’ for earlydetection and assessment of adverse drug reactions ‘ADR’ of the pharmaceutical andmedicinal products. On the other hand, three consultants physicians were interviewed in theKing Saud Medical Complex ‘KSMC’ and governmental hospital realizes the scientificvalues of the internet technology adoption in the healthcare services as a source ofpharmaceuticals and medical knowledge and they have stated that “the physicians are facedwith a barrage of new products, alternative treatments and varying medications, from thispoint the internet and medical web-based technologies are the dynamic channels and theeasiest way to updates their knowledge about pharmaceutical and clinical information”.Although the interviewed physicians recognizes the internet and related medical web-basedtechnology as a potentially alternative for delivering accurate pharmaceutical and clinicalinformation when needed 24/7, their judgment is made regarding the innovation’s clinicalbenefit (Jonathan, 2008). Interestingly, two of the interviewed physicians have commentedthat “The online disease awareness program may create a critically obsessive medicalpopulation, especially those of low medical background and if the medical website is notunder a medical consultation”. Two of the general practitioners when interviewed were inpositive trend towards using the internet technologies as a source of pharmaceutical meansand they have stated that “The internet technology offers advanced and real solutions tocustomize the large number of clinical trials and its clinical outcome relative to its adverseeffect”. A clinical pharmacist in the Ministry of Health ‘MOH’ directorates when interviewed 55
  • 56. was in agreement of the tremendous benefits of the internet technology in his daily practiceand has stated that “The internet technologies’ values are not only for updating hispharmaceutical and clinical information but, also allows comparing the outcomes andinterpretations of different clinical trials that help for a better clinical judgment”. In contrast,the only limitation claimed by the interviewees was the higher subscription cost of the onlinepharmaceutical and clinical websites and the electronic version of the medical magazines.While the sample for our qualitative interviews was small, the data from the interviewsexplored the context of the research objectives.4.2 The quantitative data resultIn a complementary manner, the quantitative aspect of this research augments the qualitativeviews mentioned above. The quantitative data was captured, collected, quantified and thenanalyzed to provide the overall features of the research hypothesis.4.2.1 Technology acceptance model ‘TAM’ variablesUsing the technology acceptance model ‘TAM’ variables, the responses of the physiciansand healthcare professional toward the internet and related web-based technology model as asource of pharmaceutical and clinical information, were grouped and quantified together tocreate overall scores for each of the variables’ items (see figure 7). The central tendency andcorrelation (r) around the mean were calculated as follow: 56
  • 57. Mean Median Mode Range Variance St.D Correlation 243.85 180.5 186 823 46270.76 215.106 0.413The chart below represents the technology acceptance model ‘TAM’ variables’ responsesscore:Whilst 71.6% of the responders showed a positive response towards the internet and relatedmedical web-based technologies as a source of pharmaceutical and clinical information, 16%of the responders showed a negative response. In between the two extremes 12.4% of themwas neither agreeing nor disagreeing that using the internet and medical web-basedtechnologies as a source of pharmaceutical information are beneficial to their practices. Thisresult is consistent with the previous findings conducted by Google (2009) which estimatedthat 73% of the physician considers the internet to be standard part of their clinical practices,and 69% of the physician trusts online clinical information. Section 4.2.2 describes in detailsthe TAM variables’ responses. 57
  • 58. 4.2.2 Technology acceptance model ‘TAM’ variables’ responses. The independent technology acceptance model ‘TAM’ variables’ responses the perceived usefulness and perceived ease of use, as well as the dependent variables the attitude and behavioural intention were grouped to create overall scores for each of the dimensions. Measures of the central tendency and correlation around the mean were calculated using the overall scores. Perceived usefulness To identify the perception of the physicians and healthcare professional toward the usefulness of the internet and web-based technologies as a source of pharmaceutical and clinical information, the variables’ items were grouped and quantified together to create overall scores for each of the dimensions (see figure 8). The central tendency and correlation (r) around the mean of the variables’ items were calculated as follow: Mean Median Mode Range Variance St.Deviation r 255.3 178.5 285 823 58844.93 242.58 0.276 The below chart represent the response’s related to the perceived usefulness variables’ items. 58
  • 59. Among the results, 21.3% of the respondents were strongly agreed while 54.2% of all respondents were in agreement of the potential benefits of the internet technology in their clinical practices. Whilst, 1.3% and 9.8% of all respondents were strongly disagreeing and disagreeing respectively the usefulness of the internet and web-based technologies as a source of pharmaceutical and clinical information, the neither rests 13.3% of them appeared neutral in their perception. Perceived ease of use As independent technology acceptance model ‘TAM’ variable, the responses for the items relating to perceived ease of using the internet and web-based technologies as a source of pharmaceutical and clinical information were grouped and quantified together to create overall scores for each of the dimensions (see figure 9). The central tendency and correlation (r) around the mean were calculated as follow: 59
  • 60. Mean Median Mode Range Variance St.D r. 241.72 186 186 644 45640.63 213.64 0.96 The below chart represent the response’s related to the perceived ease of use variables’ items: Whilst 69.1% of all respondent were in a positive extreme, 17.1% of them were in a negative extreme in perceiving the ease of using the internet and web-based technology as a source of pharmaceutical and clinical information. On the other hand, 13.8% of all respondents appear neutral in their perception. Attitude The presentation of the items related to the attitude variables’ responses, were grouped and quantified for each of the dimension (see figure 10).The central tendency and correlation (r) around the mean were calculated as follow: Mean Median Mode Range Variance St.D r. 226.467 164 355 553 29442.98 171.59 0.79 60
  • 61. The below chart represent the response’s related to the attitude variables’ items: Among the respondents, 23.8% and 42.8% of them were strongly agreeing and agreeing respectively and showed a positive attitude , while 16.5% and 4.2%% of them were strongly disagreed or disagreed respectively and showed a negative attitude toward the internet technology as a source of pharmaceutical and clinical information. The neither rest 12.5% of the respondents appeared neutral in their perception. Behavioural intention The presentation of the items relating to the behavioural intention variables were quantified and grouped to form overall scores for each of the dimensions (see figure 11). The central tendency and correlation (r) around the mean were calculated as follow: Mean Median Mode Range Variance St.D r. 72.8 57 57 144 2522.59 50.23 0.44 61
  • 62. The below chart represents the response’s related the behavioural intention variables’ items:Consistent with the above results 28% and 41.7% of all the respondents were stronglyagreeing and in agreement respectively and showed a positive attitude and intentionally usethe internet technology. In contrast, 2.1 % and 19.3% of all the respondents were stronglydisagreed and disagreed respectively and showed a negative attitude and intention to use theinternet technology as a source of pharmaceutical means, while the neither rest 8.9% of allrespondents appeared neutral in their perception.4.2.3 Descriptive statisticsThe Pearson correlation values showed strong positive linear relationships between thetechnology acceptance model ‘TAM’ variables’ responses (r/Pearson correlation values 62
  • 63. >0.6). All pairs of correlations are significant at the 95% level (p<0.05). The underline chartillustrates the correlations between the technology acceptance model ‘TAM’ variables.As a result, the relationships between the technology acceptance model ‘TAM’ variables andtheir significance in determining the physicians’ and healthcare professionals’ attitude andbehavioural intention demonstrated a strong positive trend to use the internet and medicalweb-based technologies as a source of pharmaceutical and clinical information. The chartbelow illustrates the descriptive statistics of the technology acceptance model ‘TAM’variables’ response. 63
  • 64. 4.2.4 Study findingsWithin the context of these results, perceived usefulness is the most significant determinantof the physicians’ and healthcare professionals’ levels of acceptance the internet technology.Data revealed from the technology acceptance model ‘TAM’ variables’ responses showedthat there’s strong positive correlation +0.98 between perceived usefulness and attitude, andpositive correlation +0.81 between perceived usefulness and behavioural intention of thephysicians and healthcare professional toward the internet and medical web-basedtechnologies as a source of pharmaceutical and clinical information. On the other hand,perceived ease of use showed a positive correlation +0.62 and +0.369 with the physician’sattitude and behavioural intention respectively to use the internet technology as a source ofpharmaceutical and clinical information. A moderate positive correlation +0.44 exist betweenperceived usefulness and perceived ease of use the internet technology. Consistent with a 64
  • 65. Google survey (2009), the interpretations of the above findings revealed that 75.5% and69.1% of all the respondents, showed a positive trend toward the usefulness and ease of usethe internet and medical web-based technologies as a source of pharmaceutical information intheir clinical practices. 65
  • 66. 5.0: CHAPTER FIVE: CONCLUSIONS, RECOMMENDATIONS,AND THE STUDY LIMITATIONSIn light of the study’s findings and the provided literature reviews, the present researchempirically supported the conceptual hypothesis of the internet technology as the mostreliable and the easiest source of pharmaceutical and clinical information. The datainterpretations and the study’s main conclusions and recommendations reveal itself, whilerestates the study’s limitations for further improvement.5.1 ConclusionsGenerally, from the previous study’s findings, we concluded that detailing is an importantsource of pharmaceutical and clinical information and it affects the physician’s prescriptionbehavior in a positive and significant manner (Puneet et al, 2005). At present, the richavailability of the pharmaceutical and clinical information sources to the physicians it ispossible that the in-person traditional detailing maybe retracted by online communication ande-detailing over time (Puneet et al, 2005). With rapid advances in the internet and medicalweb-based technologies, a novel way of a reliable and convenient communication betweenthe pharmaceutical companies and the physicians has emerged. To stay competitive, aleading pharmaceutical company must frequently redesigns the marketing and sales strategiesto accommodate the highly dynamic market changes and the growing communicationchallenges (Dien, 2003). Realizing globalization and fast speed communication, information 66
  • 67. technology ‘IT’ and e-commerce play a major role of business-transformation in the globalmarket. However, from the extensive literature review it was clear that gaining competitiveadvantage requires building on the proven principles of the effectiveness of informationtechnology ‘IT’ in business strategies, and by integrating the virtual and physical activity(Porter, 2001). Obviously , information technology ‘IT’ is the critical success factors ‘CSF’for driven business-transformational processes in the coming future, Alt (2003) has statedthat “Information technology ‘IT’- driven transformation in the pharmaceutical companiescreate strategic opportunities and competitive pressures at the same time” (page 3).Therefore, a leading pharmaceutical company has to integrate the e-detailing approach intothe customer relationship management ‘CRM’ technology to create the physician’s e-loyaltyand long-term e-credibility. Pharmaceutical companies will need to develop and implementinnovative strategies that capitalize on the power of the internet technology and the changesin both the traditional and electronic markets (Minakakis et al, 1999). In a synergy ways e-detailing not only strengthen the in-person communication between pharmaceutical salesrepresentatives and the physicians but also, would make the physicians more likely to see outpharmaceutical and clinical information online. Direct-to-physicians ‘DTP’ e-communicationovercomes the concern arisen from the unethical relationship between pharmaceuticalcompanies and the physicians, and create opportunities to pharmaceutical companies forlegitimating ethics, building trust, and maintaining a convenient relationship into thephysicians and healthcare professionals, the stakeholders, and the broader medicalcommunities 67
  • 68. 5.2 RecommendationsRealizing the current communication pattern between pharmaceutical companies and thephysicians in which the gratuities gifts, incentives, sponsorship of conferences and symposia,and alike is the everyday realities (Komesaroff et al, 2002). As a result, the change towards e-detailing will require a substantial shift in the attitude and values as well as the marketing andsales strategies (Paul et al, 2002). Therefore, e-detailing planning and implementationrequires support both at the management level and at the level of pharmaceutical salesrepresentatives. At present, the successful approach towards e-detailing strategies requiresinformation technology ‘IT’ specialist within the corporate level and the management level.The primary element of e-detailing techniques is the encouragement of the physician’sattitude toward the potential values of the internet and medical web-based technologies as asource of pharmaceutical and clinical information. Therefore, it is highly recommended thatpharmaceutical companies have to think of special reward system and effective incentives(Heutschi, 2003) for the use of the diversified e-detailing platforms, such as a broaderspectrum of services that support the physicians’ clinical practice. An efficientimplementation of online communication and e-detailing requires a suitable level ofintegration between offline-online activities, to act in synergistic ways (Heutschi, 2003).Within the context of the product life-cycle management ‘p-LCM’ programs, customerrelationship management ‘CRM’ technology is a tool that helps pharmaceutical companiesand the physician’s progress through the product life-cycle. However, a leadingpharmaceutical company has to realize that an efficient integration of e-detailing andcustomer relationship management ‘CRM’ technology, can provide the company with the 68
  • 69. ability to dynamically customize messaging based on physicians’ feedback, which lead todelivery of a personalized content more closely aligned with the physicians wants and needs(Eric, 2010). In this regard, pharmaceutical companies either develop their own web-sites orpartnering with a global e-customers relationship management ‘e-CRM’ technology solutionprovider, such as Cegedim Relationship Management and Johnson Controls GlobalWorkplace. In the near future, building efficient e-customers relationship management ‘e-CRM’ technology is the core competence among the others, where pharmaceuticalcompanies must pursue to achieve its reputation and to attain competitive advantages in theglobal market. With regard to the above challenges, the internet and related medical web-based technologies offer a tremendous marketing tool for strengthening communication,legitimating ethics, building trust, and maintaining a convenient relationship into thephysicians, the stakeholders, and the broader medical communities. Establishing the brandand medical services through online communication and interactive e-detailing is essential,for building long-stay a credible partnership and future trust of the company’s productsamong the physicians and healthcare professionals.5.3 Study limitationsAlthough the research has been conducted in the Saudi Arabia, which gives strong insightinto the emerging healthcare market in the gulf area, confirmatory studies are required toestablish the conceptual hypothesis of the internet and related medical web-based as apotential source of pharmaceutical and clinical information in the healthcare settings. The 69
  • 70. study focuses only on the intrinsic factors related to the technology acceptance model ‘TAM’variables, and does not take into account the impact of extrinsic factors such as the political,governmental, economical, sociological, and cultural factors that might restrict theapplication of information technology ‘IT’ and e-commerce principles in the businessstrategies. The research does not take into account the resistant to change toward e-detailingamong the company management’s level as well as the operational field force level.Additionally, the study does not examine the physician’s attitude and intention to use theinternet technology across all the age group. Realizing that e-detailing approach has beensuccessfully implemented in a homogeneous and advanced healthcare market such as the US(Heutschi, 2003), the present research did not define a proper e-detailing approach to beimplemented in a heterogeneous and the developing healthcare market. 70
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  • 102. 102
  • 103. 103
  • 104. Figure 7: Technology Acceptance Model TAM variables responsesTAM variables Variables Strongly agree S.values Agree S.values Neutral S.values Disagree S.values Strongly disagree S.values 1 57 285 161 644 67 201 57 114 22 22 2 69 345 167 668 42 126 55 110 31 31 3 79 395 181 724 51 153 48 96 5 5 4 71 355 207 828 35 105 39 78 12 12Perceived usfulness items 5 41 205 143 572 57 171 97 194 26 26 6 23 115 181 724 69 207 77 154 14 14 7 38 190 178 712 62 186 78 156 8 8 8 57 285 165 660 71 213 52 104 19 19Sum 435 2175 1383 5532 454 1362 503 1006 137 137 9 69 345 163 652 62 186 62 124 8 8 10 63 315 152 608 33 99 87 174 29 29Perceived ease of use items 11 62 310 161 644 62 186 48 96 31 31 12 12 60 48 192 57 171 224 448 23 23 13 82 410 161 644 63 189 41 82 17 17Sum 288 1440 685 2740 277 831 462 924 108 108 14 72 360 149 596 34 102 57 114 52 52Attitude items 15 71 355 117 468 46 138 82 164 48 48 16 19 95 98 392 62 186 142 284 43 43Sum 162 810 364 1456 142 426 281 562 143 143 17 35 175 87 348 57 171 156 312 29 29Behavioural intention items 18 42 210 156 624 42 126 102 204 22 22 19 62 310 104 416 18 54 142 284 38 38 20 126 630 147 588 22 66 57 114 12 12Sum 265 1325 494 1976 139 417 457 914 101 101TAM variables responses 5750 11704 3036 3406 489TAM variables scores (%) 23.58007 47.99672 12.45028 13.967603 2.0053311 104
  • 105. Figure 8: Perceived usefulness Strongly agree Agree Neutral Disagree Strongly disagree Value % Value % Value % Value % Value %1-I would fine using the 285 2.791 644 6.3 201 2 114 1.1 22 0.21543internet as a source ofinformation useful in my job2-I like to use the internet 345 3.378 668 6.5 126 1.2 110 1.1 31 0.30356web-sites as the primary sourceof pharmaceutical information3- Using the internet as a source 395 3.868 724 7.1 153 1.5 96 0.9 5 0.04896of pharmaceutical informationcould improve mypractice and patient care4- Using the internet as a source 355 3.476 828 8.1 105 1 78 0.8 12 0.11751of pharmaceutical informationwould safe my time and effort5- I frequently use the web-sites 205 2.007 572 5.6 171 1.7 194 1.9 26 0.2546pharmaceutical informationbecause of the accuracyofof product information6- I frequently use the web-site 115 1.126 724 7.1 207 2 154 1.5 14 0.13709pharmaceutical informationbecause of the quality of content7- I frequently use the web-site 190 1.861 712 7 186 1.8 156 1.5 8 0.07834pharmaceutical informationbecause of the quantity of content8- Using the internet as a source 285 2.791 660 6.5 213 2.1 104 1 19 0.18606 of pharmaceutical informationenhance my effectivenessin my practice and patient care Sum 2175 21.3 5532 54 1362 13 1006 9.9 137 1.34156 105
  • 106. Figure 9: Percieved ease of use Strongly agree Agree Neutral Disagree Strongly disagree Value % Value % Value % Value % Value %9-I find find pharmaceutical product 345 5.709 652 11 186 3.08 124 2.1 8 0.13238web-sites easy to navigateand obtain clinical information10-Using the intenet and web-sites 315 5.213 608 10 99 1.64 174 2.9 29 0.47989as a source of pharmaceuticalinformation would be easy for me11- It would be easy for me to become 310 5.13 644 11 186 3.08 96 1.6 31 0.51299skilful at using the internet andweb-sitesas a source ofpharmaceutical information12-Interacting with the internet and 60 0.993 192 3.2 171 2.83 448 7.4 23 0.38061web-sites to search for pharmaceuticalinformation is often frustrating13- Using the internet and web-sites 410 6.785 644 11 189 3.13 82 1.4 17 0.28132pharmaceutical informationis a good idea Sum 1440 23.83 2740 45 831 13.8 924 15 108 1.78719 106
  • 107. Figure 10: Attitude Strongly agree Agree Neutral Disagree Strongly disagree Value % Value % Value % Value % Value %14- Using the internet as a source of 360 10.6 596 18 102 3 114 3.4 52 1.53076pharmaceutical informationwould be beneficial to my practice15- I would enjoy using the internet 355 10.45 468 14 138 4.06 164 4.8 48 1.41301to search for pharmaceuticalinformation16- I often didnt see pharmaceutical 95 2.797 392 12 186 5.48 284 8.4 43 1.26582sales representative in my dutiesbecause of time constraints Sum 810 23.84 1456 43 426 12.5 562 17 143 4.2096 107
  • 108. Figure 11: Behavioural intention Strongly agree Agree Neutral Disagree Strongly disagree Value % Value % Value % Value % Value %17- I frequently use the web-sites 175 3.697 348 7.35 171 3.61 312 6.59 29 0.61272pharmaceutical informationdelivered by the salesrepresentative is subject to bias18- I intend to use the internet 210 4.437 624 13.2 126 2.66 204 4.31 22 0.46482as a source of pharmaceuticalinformation as often as needed19- I would frequently use the 310 6.55 416 8.79 54 1.14 284 6 38 0.80287internetand web-sites as a sourceof pharmaceutical informationin my practice20- I plan to use the internet and 630 13.31 588 12.4 66 1.39 114 2.41 12 0.25354web-sites technology as a sourcepharmaceutical informationin the future Sum 1325 27.99 1976 41.7 417 8.81 914 19.3 101 2.13395 108

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