The factors influencing customer choice of pharmaceutical brands in Sulaimani

: The pharmaceutical industry is an important component of health care systems throughout the world; it is comprised of many public and private organizations that discover, develop, manufacture and market medicines for human and animal health, as Physicians play major role in the selection of medicine to consume, this study aims to determine the most important factors influencing physician prescription behavior (medicine brand choice). In order to achieve this objective, a self-administered questionnaire designed, it was completed by 77 physicians in Sulaimani city. Iraq. Data were analyzed applying various statistical methods, such as descriptive statistics, and ANOVA. The results show that, the most important factors influence physician’s prescription behavior are patient compliance, medicine efficacy, patient buying power, and medicine availability respectively. this research suggests that future research may explore the factors influencing patient’s choice for over the counter medicine (OTC).

Al-Ghari Journal of Faculty of Administration and Economics 386

1.Introduction:
The pharmaceutical industry is an important component of health care systems throughout the world; it is comprised of many public and private organizations that discover, develop, manufacture and market medicines for human and animal health.The pharmaceutical industry is based primarily upon the scientific research and development (R&D) of medicines that prevent or treat diseases and disorders.pharmaceutical industry has shown enormous growth in the last half-century due to sustained demand for novel therapies, as well as ever-increasing competitive pressures.(Stros & Lee, 2015,318) However, Kurdistan pharmaceutical market has shown its progress since the first pharmaceutical company (Awamedica) has been established in 2006 in Erbil city, then (Pioneer) in 2011 in Sulaimani, as well as (Rasan)which is under construction in Sulaimani city.
Physicians in pharmaceutical industry play an important role for the selection of medication or treatment methods in order to best fit the patients' health condition.Studies showed the physicians as a source of power in the physician-patient relationship.(Macit et al, 2016, 4) In general, pharmaceutical companies spend more on their marketing activities than on research and development, thus, pharmaceutical companies in Kurdistan are facing a huge competition from foreign companies.As well as, local physicians have a big range of pharmaceutical brands to choose one of them and prescribe it to patients.Therefore, it is very important to pharmaceutical companies to know what are the factors influencing their costumer's choice of medicine brand, as the customer is considered the king of the scenario of marketing nowadays.
Understanding costumer behavior is still arduous in the field of pharmaceuticals as the target customer is not the end user but the influencer i.e. the doctor who generates the prescription (Pujari & Sachan, 2016,11).Therefore, this research investigates the most important factors influencing physicians' choice of pharmaceutical brands as they are the influencers and decision makers, not the patient.
Regarding to the lack of local studies investigating the most important factors can affect physicians' pharmaceutical brand-choice decision, which can help local pharmaceutical companies to develop evidence-based successful marketing strategies toward their customers.Based on what has been mentioned, main purpose of this study is to investigate the factors influencing customer choice of pharmaceutical brands which implies the following specific purpose: Determine the most important factors that influence physician's prescription behavior.
The significance of the study is considered by the lack of published literature regarding the issue of customer choice in pharma industry in Kurdistan, which may be attributed to the relative recentness of the pharmaceutical companies and due to the way` the marketers of them being involved too much in the reactive competition practices and traditional marketing practices such as advertising and price competition and not paying much attention to marketing research.Therefore, this study can make a good contribution to launch a literature regarding the customer choice of pharmaceutical brands in Kurdistan as it is the first study investigating this subject in Kurdistan.
Since this study investigates the most important factors influencing customer choice of pharmaceutical brands, the findings of this study will have practical implications for marketing and enrollment management of the pharmaceutical companies in Kurdistan.Understanding how physicians select a particular brand can be of a great importance because of its implications on how effective and successful marketing strategies can be developed and implemented.

2.Literature review:
Pharma industry with its unique anatomical structure is differentiated from other industries in the way it reaches the end consumer (patient), as the patient is usually not the decision maker in this process.Ronoh (2002) highlights the characteristic feature of the pharmaceutical marketing is that one reaches the end consumer (patient) through an intermediate customer (physician/doctor) who advises the end customer.Stros & Lee, (2015) also conduct that One specific peculiarity of pharmaceutical industry is the unique situation that the actual prescription decision is not made by the payer or the patient, but by the physician that takes place within this specific business area.
In addition Mecit et al (2016) mention that Physicians play major role in the selection of medicine to consume and can also be considered as the consume Moreover, G & AY( 2015) state that The decision on what medicines to consume is not determined by the patients' taste, but primarily by the preference of the physician.Therefore, physicians can also be considered as the consumer.
From the last few years, pharmaceuticals are on the track to get competitive advantage and good market share by working on strategies to make more and more loyal customers, increasing customer understanding and providing more appealing as well as attractive promotional activities.For pharmaceuticals, captivating physicians' loyalty means achieving huge market share and competitive advantage by health care professionals (doctors) in the tough marketplace (Hussain & Hussain, 2016)  The most important and significant factor for an organization to be successful is the customer.Since the customer is the foundation for success for any organization this means that every organization has a mission to create customers, and does the best it can to satisfy the needs of its customers, a mission which if the organization fails to attain, it will mean that the organization will not stand under competitive conditions, and it will not be able to survive and prosper (Qasim,2016).
the Competition is increasing day by day in business arena and one who reacted timely against these frequent changes can survive in the competition, same in the field of pharmaceutical industry, every day different companies are bringing different brands with continuously increasing the size of market.In this competition physicians are the key customers for this industry.Physicians are actually the ultimate decision holder of which brand of medicine should be prescribed to their patients. .(Shamimulhaq et al , 2014).Mirabi, Akbariyeh, & Tahmasebifard (2015) state that market researchers and organizations spent billions of dollars on consumer research to determine important factors that influence their decisions.The analysis of consumer behavior is effective in distinguish the orientation of consumers' behavior.By behavior we here refer to the concept of "consumer buying behavior" or what can be also referred to as buying decision-making process (Reddy, 2014).Consumer buying behavior studies how individuals, groups and organizations select, buy, use and dispose of goods or services to satisfy their needs and desires and, what factors affect this behavior (Kotler & Armstrong, 2014).
As the behavior of physicians when they choose a particular brand of medicine to prescribe it to their patient reflects consumer buying behavior concept in other industries, in this study the term "customer choice" is used to refer to the concept of (prescription behavior of physicians).
Medicine-choice decision is a complex process that involves a number of factors.In many cases, the decisions of physicians are multifactorial.Physicians may adopt several strategies when making prescribing decision, and several kinds of critical heuristics in conducting their duties of patient treatment (Ali Murshid & Mohaidin, 2017).According to Emmerton and Benrimoj (1991) product formulation and successful self-use of products were calculated as the most important influences on product recommendation by pharmacists.Nyagonde (2003) Considered important factors affecting prescription behavior in Kenya such as sponsorship of conferences and medical camps and also extra services rendered to physicians.
However, there are plenty of factors that researchers studied their importance in medicine choice decision by physicians.In this study those factors are divided into three groups:

Medicine characteristics:
-price: plenty of studies investigated the importance of price in affecting customer choice of medicine brand.Doctors' price sensitivity of medicine is an important issue in developing countries and it is the center of interest for fair pricing.(Ahmed, et al ,2013) -medicine efficacy (quality): Waheed, (2011) highlighted that physicians manufacture viewpoint regarding the quality of the drug based on the results they obtain through recommended treatments.If the product is found to be functional then physicians prescribe the recommended product again and again in treating diseases in upcoming patients.

-brand image:
Brands create strategic positions and specific perceptual associations in the minds of consumers (Henderson et al. 1998).

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A well-established and renowned image of a brand is one of the advantageous resources for any organization because brand image contributes in attaining superior customer loyalty which ultimately results in greater profit and revenue as well as better mutual aid and assistance (Hussain & Hussain, 2016) -Source of brand(origin): Brand origin does play a key role in physician's prescribing habits as it allows the physician understand the stringent policies and regulatory challenges put forward to the drug for it to get to market.(Kenny,2013)

promotion related factors:
-Medical representative: Personal selling is the primary tool pharmaceutical firms depend upon to promote their products because the target customers are special who are not consumers rather simply influencers, the physicians, and medical representatives are considered to be the face of promoting firms.(Hussain & Hussain, 2016) It is considered as a vital marketing instrument for promoting prescription medicin.as it has positive and statistically significant effect on the number of new prescriptions issued by a physician.,The sales person's personality as well plays an important role for the sales effectiveness (Stros & Lee, 2015) -word of mouth: an actively supported distribution of positive messages via opinion leaders (word-ofmouth) will improve the effectiveness of promotional actions.This (Stros & Lee, 2015) Therefore, this leads to the conclusion that a support of personal selling by direct-toconsumer an actively supported distribution of positive messages via word-of-mouth can improve the effectiveness of promotional actions.'Marketers of new pharmaceuticals should also not underestimate the importance of gaining publicity and positive word-of-mouth among patients (Stros & Lee, 2015) -gifs: Patients play a significant role in influencing the physician choice of medicine, the patients are increasingly asserting their preference on the medicine brands that physician or pharmacists recommends for them.A patient will convince the prescriber to issue a prescription of a brand that had been used previously by the patient or a close associate with good results.(Nyagonde, 2003).Albadr & Khan ( 2015) support this statement as well, that the patient is aware or knowledgeable, he/she can ask the pharmacist for the same medicine which they used before.

research methodology:
The research adopted the quantitative approach because of its practicality and fit-forpurpose reasons, and the research design adopted for this research was the nonexperimental survey research design with comparative research design.Then the population of research was presented which are physicians in Sulaimani city, convenience sampling techniques were used in order to draw the sample of the study which consisted of 77 participants.
The instrument of the research which was a questionnaire developed by the researcher based on the review of existed literature was also described and the issues of its validity and reliability were also discussed.the data were analyzed through SPSS including descriptive statistics, ANOVA.
The main purpose of this research is to identify the most important factors influencing customer choice of pharmaceutical brands.in order to achieve this purpose, a set of questions were developed based on an in-depth review of literature and the developing of a theoretical framework of research.
the research questions should be on-topic to support the main purpose of the research, furthermore, they must be clearly defined by the researcher as they are the basis of the research design.Therefore, the study is guided by the following questions: 1-What are the most important factors influencing physician's prescription behavior?
2-Does the relative importance of factors differ by physician's gender, and work experience?

4-findings:
This study aims to explore the most important factors influencing physician 3 -385 P.After that the item (medicine efficacy) has a maximum weighted mean after item (patient compliance) that is equal to (4.48) which is greater than the theoretical mean (3) with standard deviation (0.89), also this item indicate to (88.3) with level of important and very important, but (7.8) amount of neutral level, the (3.9) with level of not important at all and low important.
The item (gifts) a minimum weighted mean which is equal to (1.66), and its smaller than the theoretical mean (3), with standard deviation is equal to (1.01), this item indicate to (33.25) with level of not important at all and low important, but (10) amount of neutral level, the ( 5) and(1) with level of important and very important respectively.
After that the item (TV advertising) has the minimum weighted mean after the item (gifts) that is equal to (2.03) which is greater than the theoretical mean (3) with standard deviation (1.22), also this item indicates to (48.1) and (20.8) with level of important and very important respectively.There are two sub-questions underpinning the second question:

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H1: There is a significant difference between physicians from different gender regarding to the relative importance of factors.
H2: There is a significant difference between physicians according to their work experience regarding to the relative importance of factors.
ANOVA was chosen to test whether there was a significant difference among(physicians) form different genders as well as work experience, and specialization for physicians.
The first hypothesis (H1) was tested by using analysis of variance, which states that "The relative importance of factors differ by physician's gender", the results are shown in the table below:  (2) gives both between-groups and within-groups sums of squares, degrees of freedom etc.In order to verify whether the differences are statistically significant or not, the data were analyzed by using analysis of variance of physician's factors according to gender, the p-value is equal to (0.371) which is greater than the acceptable statistical level (Alpha) that is equal to (α = 0.05), this means that there are no statistically significant differences in the factors importance for physician according to gender., so the first-sub hypothesis (H1) can be accepted.
The second hypothesis (H2) was tested by using analysis of variance, which states that "The relative importance of factors differ by physician's work experience", the results are shown in the  (3) gives both between-groups and within-groups sums of squares, degrees of freedom etc.In order to verify whether the differences are statistically significant or not, the data were analyzed by using analysis of variance of physician's factors according to work experience, the p-value is equal to (0.048) and which is less than the acceptable statistical level that is equal to (α = 0.05), this means that there are statistically significant differences in the factors importance for physician according to work experience, so the first-sub hypothesis (H2) cannot be accepted .Although we can determine the reasons of this differences as shown in table (4) below:  4) shows the differences of physician's work experience were appeared between 6-10 years with 16 -20 years and more than 20 years by p-values (0.044 and 0.049) respectively, which are less than the acceptable statistical level, this means that there are statistically significant differences between them.On the other hand, the differences of physician's work experience were appeared between 11-15 years with 16 -20 years and more than 20 years by p-values (0.034 and 0.048) respectively, which are less than the acceptable statistical level, this means that there are statistically significant differences between them.
Faculty of Administration and Economics Vol.18 (No.3) 2022 -Al Al-Ghari Journal of Faculty of Administration and Economics 389 2.2 factors influencing prescription behavior: previous studies have shown that the physicians' prescribing behavior can be influenced by several factors.Hemminki (1975) conducted a review of the factors affecting medicine prescribing in Western countries.Factors discussed are education, advertising, colleagues, control and regulation measures, demands from society and patients and physician's characteristics.Hartzema et al (1983) as well identified non-medical factors as important predictors of total prescribing volume among physicians.
Faculty of Administration and Economics Vol.18 (No.3) 2022 -Al Al-Ghari Journal of Faculty of Administration and Economics -Haddad et al.'s (2014) study conduct that doctors' prescribing habits change based on the marketing techniques of pharmaceutical sales representatives, such as gifts, meals, symposium sponsorships, recreational outings and other incentives 3

P
Ghari Journal of Faculty ofAdministration and Economics Vol.18 (No.3)  2022 -AlAl-Ghari Journal of Faculty of Administration and Economics 392 prescription behavior.In order to answer the first research question "what are the most important factors influencing physicians' prescription behavior?".Since the questions is descriptive research questions in nature, descriptive analysis (weighted mean, standard deviation, coefficient of variance, and relative importance) was performed to address the most important factors influence physician's choice of pharmaceutical brans.

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Does the relative importance of factors differ by physician's gender?2-Does the relative importance of factors differ by physician's work experience?To answer the second research question, which is comparison research question, along with its sub-questions and corresponding hypotheses: Faculty of Administration and Economics Vol.18 (No.3) 2022 -Al Al-Ghari Journal of Faculty of Administration and Economics

Table ( 1
): Weighted Mean and Standard Deviation of Items for physician's factor Ghari Journal of Faculty of Administration and Economics Vol.18 (No.3) 2022 -Al Ghari Journal of Faculty of Administration and Economics Vol.18 (No.3) 2022 -AlTable(1) shows weighted mean and standard deviation of each item of factors influencing prescription behavior for physicians, The item (patient compliance) has a maximum weighted mean which is equal to (4.49), and that is greater than the theoretical mean (3), with standard deviation is equal to (0.75), this item indicate to (89.6) with level of important and very important, but (7.8) amount of neutral level, the (2.6) with level of not important at all and low important.
P P

Table ( 2
) Results of variance analysis (ANOVA) physician's factors according to gender

table below
Ghari Journal of Faculty of Administration and Economics Vol.18 (No.3) 2022 -Al Al-Ghari Journal of Faculty of Administration and Economics 396 P

Table ( 3
) Results of variance analysis (ANOVA) physician's factors according

Table ( 4
) Results of Multiple Comparisons of physician's work experience