BackgroundStudies around the world have shown that interactions between pharmaceutical companies, pharmacists and physicians have a great influence on prescribing and drug dispensing practices. In middle-income countries, the nature and extent of these interactions have not been well researched. Our objectives were to qualitatively explore the nature of the interactions between pharmaceutical companies, physicians and pharmacists, their impact on drug prescription and dispensing practices in Lebanon.Methods and findingsWe used grounded theory approach as well as the known sponsor, purposive, and snowballing sampling strategies to identify interviewees from the three respective groups: physicians, pharmacists, and pharmaceutical representatives. We conducted semi-structured and analyzed transcripts thematically. This study encompassed 6 pharmaceutical representatives, 13 physicians and 13 pharmacists. The following themes emerged: purpose and driver for the interactions, nature of the interactions, incentives, impact on prescription practices, ethical considerations, and suggestions for managing the interactions. The main purposes for the interaction were educational, promotional, and monitoring prescription practices and dispensing, while the main drivers for these interactions were market potential and neighborhood socio-economic status. Physicians, pharmacists and pharmaceutical representatives who engage in these interactions benefit from a variety of incentives, some of which were characterized as unethical. It appears that pharmaceutical companies give prominence to selected physicians within their communities. Although members of the three interviewed groups refer to some of the interactions as being problematic, they described a culture of acceptance of gift giving. We developed a framework that depicts the prevailing politico-cultural environment, the interactions between the three professional groups, and their impact on drug prescription. Underreporting is the main limitation of this study.ConclusionInteractions between physicians, pharmacists and pharmaceutical representatives are frequent. Although these interactions can be beneficial, they still have a substantial effect on drug prescription and dispensing practices. Hence, the need for new policies that regulate these interactions and penalize any misconduct.

The author wishes to extend his sincere appreciation to Dr. Mohamed Harajli for giving him an opportunity to work on this thesis and for providing him support. The author would like to express his profound gratitude to Dr. Elie Hantouche for his assistance and excellent guidance throughout the course of this research. The author is also very grateful to Dr. Ghassan Chehab, for his acceptance to participate in the graduate committee and his approval of this thesis. Without their invaluable advice, patience and feedback this work would not have been possible. The author also wishes to thank all the faculty members of the Department of Civil Engineering of the Faculty of Engineering and Architecture at the American University of Beirut, for granting him the adequate education and knowledge to help during the academic years. The author takes the opportunity to express his deep indebtedness to his role model and lifetime mentor, his father, Anwar S. Haddadin.