Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s (AMA’s) ethical guidelines on gifts from the pharmaceutical industry.
Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms (eg, peers, patients, etc), facilitating conditions (eg, knowledge of the guidelines, etc), profession-specific precedents (eg, institution’s policies, etc), individual-specific precedents (physicians’ own discretion, policies, etc) and intent. Multivariate regression modelling was conducted.
Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% (n = 133) of respondents were aware of the guidelines; 50% (n = 107) had read them. 48% (n = 102) thought that following the guidelines would increase physicians’ credibility and professional image; 68% (n = 145) agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education (CME) events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent (R2 = 0.52, p <0) were attitude, subjective norms, the interaction term (attitude and subjective norms), sponsorship of CME events and individual-specific precedents.
Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance.
- AMA, American Medical Association
- CME, continuing medical education
- OIG, Office of the Inspector General
- PhRMA, Pharmaceutical Research and Manufacturers of America
- TRA, Theory of Reasoned Action
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Funding: This study was funded in part by the University of Florida Perry A Foote small grants program: $2000.
Competing interests: None.
Ethical approval: This study was approved by the Institutional Review Board at the University of Florida on June, 2004.