Impact of socioeconomic status on physician’s prescribing behavior and patient’s health behavior: perspectives from a developing country
Publication Type
Conference Paper

Purpose To investigate prescribers’ perspectives of patient’s socioeconomic status and to investigate the relationship between patient’s socioeconomic status, health behavior and physician’s choice on multisource solid oral hypoglycemic and antihypertensive drugs. Methods Initially, 20 in-depth semi-structured interviews were conducted with prescribers in Lahore, Pakistan. Interviews scripts were analyzed for socioeconomic indicators. A two round Delphi process was followed to elicit the opinions of a panel of prescribers on the influence of prescriber’s defined socioeconomic indicators on their prescribing behavior. Similarly, a bipolar 5-point Likert rating scale was used to elicit influence of these indicators on prescribing behavior of physicians originated from urban and rural areas. Fieldworkers interviewed and administered a questionnaire on adult male patients (N=506) with diabetes mellitus and concurrent hypertension who were stabilized with drug treatment, dietary intake and health behavior. Relationship between potential socioeconomic indicators was tested with Spearman’s statistics. Adherence to drug, dietary intake and health behavior was tested with bivariate analysis. Interclass mean prescribed drug price ratios were tested with ANOVA. Results During interviews, physicians gave 15 potential socioeconomic indicators. Following two Delphi rounds, consensus was reached on 11 (73.3%) indicators, whereas, the remaining 4 (26.7%) were highly disputable. Bivariate analysis showed that literacy, educational background, compliance to medicine, diet and exercise, dress and appearance were important indicators at the time of clinical decision making for physicians originated from urban areas than for a physician originated from rural areas. Social network was more important indicator for physicians originated from rural areas. Patient’s socioeconomic status was best indicated by income and occupation (Spearman’s Rho=0.88, p<0.01). Patients with high socioeconomic class were more adherent to drug, dietary intake and health behavior than their socioeconomically lower counterparts (χ2 =13.16, p<0.001; 34.71, p<0.0001; 79.24, p<0.0001, respectively). Patients with lower socioeconomic status were prescribed cheaper drugs than their counterparts (p<0.01). Conclusion Differentials in physician’s prescribing behavior in function of patient’s socioeconomic status exist in developing countries. Physicians originated from urban and rural areas view socioeconomic status differently.

Conference Title
AAPS Annual Meeting and Exposition, October 23-27, 2011, Walter E. Washington Convention Center, Washington DC, USA
Conference Country
United States of America
Conference Date
Oct. 23, 2011 - Oct. 27, 2011
Conference Sponsor
American Association of Pharmaceutical Scientists