Patient perceptions of incentive-linked prescribing in Pakistan

Background: Incentive-linked prescribing (ILP) – doctors’ accrual of incentives from pharmaceutical companies through prescribing promoted drugs – is a well-documented issue. However, little is known about patients’ perceptions of ILP and the extent to which it can affect their trust in doctors in Pakistan.Methods: A qualitative approach was adopted to collect data from 25 conveniently selected patients visiting pharmacies with prescriptions from their doctors, in Karachi, Pakistan. A thematic analysis technique was used to analyse patients’ perceptions of ILP.Results: Our analysis revealed that a majority of patients were aware of the profit-oriented relationship between doctors and pharmaceutical companies. Patients thought both doctors and pharmaceutical companies were highly motivated to maximise profits through ILP, which they believed was an unethical practice with negative consequences for patients. In addition to commissions linked with prescribing and dispensing medications, patients named several other incentives and benefits that pharmaceutical companies provided doctors with. Many patients also spoke about how pharmacists perform a catalytic role to enable ILP by selling specific pharmaceutical products to patients, for which they received commissions.Conclusion: There is growing awareness of unethical relationships between doctors and pharmaceutical companies, which significantly contributes to patients’ mistrust of doctors; this not only harms doctors’ reputations in society but also affects their compliance with doctors’ advice, which is likely to have negative implications for healthcare delivery.