3.2.1 Objectives & Scope
The purpose of the review is to study the literature in order to gain an understanding of the factors and contexts that influence physician prescription behaviour.
Specifically, the review will:
Identify and map factors and contexts having a bearing on physician decision behaviour when prescribing
The scope of the review is highlighted in Table 3-3 Scope of systematic review.
Table 3-3 Scope of systematic review
Focus The focus of the review is on factors and contexts influencing physician prescription behaviour.
Source: knowledge must be produced by organizations adhering to accepted academic methods of inquiry and be research based.
Content: knowledge must be generated following academically accepted methodologies and aligned with appropriate epistemologies.
Time Frame Searches will be conducted from 1980 onwards, as this denotes the time from which modern regulation of promotion of medicines was instituted.
Literature earlier than this will be included if cross referenced within the original search frame.
Language English only
Discipline The review will examine the management, marketing, health economics, psychology and medical literature. List is not exhaustive, and flexibility will be key to extracting available information.
3.2.2 Search Strategy
The nature of research into physician prescribing behaviour makes it difficult to confine available literature into one specific domain (Mikkelsen, 2010). Therefore, the search strategy included databases and literature covering medicine, marketing, economics, health care, policy health technology assessment and decision-making. Consequently, the search for publications addressing the research question was conducted in citation databases, grey literature (SIGLE:
International System for Grey Literature), references from other sources and manual searches of specific journals.
The following citation databases were searched:
MEDLINE
EMBASE
PROQUEST
EBSCO
Web of Science
Science Direct
Emerald
PsycINFO
ERIC
Cochrane
Index to Thesis
In addition, references from the following sources were also included in the review:
References suggested by the review panel, knowledgeable researchers and practitioners
List of references from selected papers
Personal library (1050 books and articles)
SIGLE was searched, but only contained unpublished work more than three years old. The protocol pre-specified that only unpublished work of 2 years or less would be included, thus SIGLE was not included in the review.
Finally, manual searches based on findings from the scoping study were performed in the following sources:
International Journal of Research in Marketing
Journal of Marketing
Journal of Law and Economics
Social Science Medicine
The Academy of Management Review
Marketing Research
Medical Decision Making
Management Science
Journal of Advertising Research
Journal of the American Medical Association
British Medical Journal
The search terms listed in Table A-3 Systematic review search terms were used to locate relevant studies and documents. These search terms were combined into search strings in the different databases to be combined as appropriate (see Table A-10 Systematic review search strings for details).
3.2.3 Information and Data Handling
The details (database collections, search strings, number of documents retrieved and number of documents initially selected) of the searches were captured and documented in Microsoft Excel using two by two tables including a unique identifier for further tracking. EndNote X5 was used for citation storage and management. Microsoft Excel 2010 and SPSS 19 were used for analysis and synthesis of data.
3.2.4 Selection of Publications
The selection of publications to be included in the systematic review was achieved through a predefined staged approach.
3.2.4.1 Stage 1: Selection by Title and Abstract
Papers were selected if they addressed the following aspects:
Frameworks and theoretical underpinnings of physician decision behaviour having a bearing on prescription behaviour
Factors, interventions and contexts that influence physician decision behaviour
3.2.4.2 Stage 2: Selection by Full Text
Documents selected at stage 1 underwent a second selection stage with the following criteria:
Conceptual overview: papers included were those that addressed the key issues, framework and theoretical underpinnings of physician prescription behaviour.
Review of factors and contexts influencing physician prescription behaviour: Papers exploring factors and/or contexts influencing physician decision behaviour when prescribing were included at this step.
3.2.5 Quality Appraisal & Review Panel
Quality Appraisal criteria has been adapted from (Tranfield, Denyer, & Smart 2003) and was applied to and documented for all literature selected for inclusion at stage 2. Only literature appraised as being of high and medium quality was included in the review. Furthermore, non-peer reviewed literature was appraised by a second reviewer (Dr. Javier Marcos), and judgement on reputability of source was made. Only non-peer reviewed literature from a reputable source, such as academic and government institutions, having passed the quality appraisal criteria by the second reviewer, was included in the review. The review panel served as the final decision authority for all literature included in the review.
The review panel consisted of the reviewer (Yngve Mikkelsen), lead supervisor (Dr. Javier Marcos), a senior academic supervisor (Professor Hugh Wilson) and senior academic supervisor (Professor Simon Knox).
Table 3-4 Review panel members
Person Role / Title and organization
Yngve Mikkelsen MD Researcher, doctoral student, Cranfield School of Management
Dr. Javier Marcos Lead supervisor, lecturer, Cranfield School of Management.
Prof Simon Knox Senior supervisor, professor, Cranfield School of Management
Prof Hugh Wilson Senior supervisor, professor, Cranfield School of Management
3.2.6 Descriptive Analysis and Data Extraction
The data was extracted from the studies and input into EndNote X5, and subsequently into Microsoft Excel 2010 and SPSS 19 (please refer to Table A-6 Data extraction form and Table A-12 Systematic review data extraction results for details). After extracting the data for the descriptive analysis, relevant information was imported and coded in SPSS 19. Furthermore, a factor analysis was performed to quantitatively interrogate the dataset for common themes and validate the selection of themes for further analysis and synthesis of the evidence.
3.2.7 Synthesis and Analysis
A qualitative synthesis of the publications selected for review was conducted using the framework proposed by Wallace and Wray (2006). Emerging themes were identified and grouped into dimensions following a retroductive analysis approach.
Table 3-5 Principles of synthesis summarizes some principles of good synthesis methods (Tranfield et al., 2003) and how the synthesis strategy of this systematic review met these principles.
Table 3-5 Principles of synthesis
Principles Strategy: Approach and methods
Synthesis method appropriate
to research 1. Explore and map the key issues, frameworks and theoretical underpinnings of physician decision behaviour having a bearing on prescription behaviour
2. Investigate factors that influence physician decision behaviour,
3. Investigate contexts under which these factors influence physician decision behaviour.
Cope with diffuse and
heterogeneous data Summaries of the studies following the Wallace and Wray framework will be import into SPSS 19 facilitating handing of diffuse and heterogeneous data.
Transparency and detail of content allowing reader to adequately gauge quality of method, data and conclusion
Transparent and exhaustive referencing of material included in the review will allow the reader to interpret and validate the conclusions of the review.
Ensure audit trail Studies included and excluded from the review will be reported. Comprehensive descriptive analysis tables and coding in SPSS 19 will provide audit trials.