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Local Project Report

On

TO STUDY THE EFFECTIVENESS OF


PHARMACEUTICAL DETAILING ON THE
PRESCRIBING HABIT OF PHYSICIANS

Submitted to Manipal Institute of Management

In partial fulfillment of the requirement for

Master of business administration (2007-10)


Submitted By: PAPPU SHARMA

AJAY KUMAR

RAMESH KUMAR CHAUDHARI

SAROJ KUMAR

(IMP VIth SEM)

MANIPAL INSTITUTE OF MANAGEMENT

MANIPAL

MANIPAL UNIVERSITY

MANIPAL
Acknowledgement

We would like to acknowledge the support and encouragement received from our project
guide, Mr.S Lakshminarayanan ’, faculty Manipal Institute of Management (MIM),
Manipal, without whose help this project could not have been successfully completed.

We express my sincere thanks to Mr A J Joshua FACULTY, MIM ,Manipal and our project
guide for their guidance and regular feedbacks.

Last but not the least; we would like to thank ICI India, which provided us with this great
opportunity and learning experience.

(Pappu Sharma)
(Ramesh Kumar Chaudhary)
(Ajay Kumar)
(Sroj Kumar)
Declaration

We hereby declare that the local project entitled “Study of the effectiveness of
pharmaceutical detailing on the prescribing habit of physician” has been submitted during the
year 2009-2010 under the valuable guidance and supervision of ‘Mr. S. Lakshminarayanan
and Mr A J Joshua ’, faculty Manipal Institute of Management (MIM), Manipal, in partial
fulfillment of the requirements of the Masters of Business Administration (MBA) degree of
Manipal University.

Pappu Sharma

Ramesh kumar chaudhary

Ajay kumar

Saroj kumar
Contents

PARTICULARS
Page No

Executive summary

CHAPTER 1:

(1.1) Introduction

(1.2) Need of study

(1.3) Literature review

CHAPTER 2:

(2.1) Title of the Project

(2.2) Research Objective

(2.3) Limitation Of Study

(2.4) Research Methodology

CHAPTER 3:

Data analysis

CHAPTER 4:

Findings

CHAPTER 5:

Suggestions

CHAPTER 6:

Conclusions

ANNEXURE

Bibliography

Appendix

 Questionnaire
List of Tables
Table No Particulars Page
No

3.1 Up –to- date information

3.2 Usefulness of information

3.3 Reliability of information


4
Factor physician consider when prescribing

4.A
Consideration of clinical knowledge

4.B Consideration of peer reviewed journal


4.C Consideration of clinical practice guidelines
4.D Consideration of colleagues and peer
4.E Consideration of patient financial status
4.F Consideration of pharmaceutical company representative

4.G Consideration of patient personal opinion

5.0
Maximum impact of Rx behaviours

6 Physician value the work of pharmaceutical company


representative

6.A Drug Interaction

6.B Latest drug and treatment

6.C Assistance programme for prescription coverage

6.D Free drug sample

Presentation for physician and staff


6.E

6.F Reports of side effect

7.0 Effective component of detailing

8.0
M.R repetitive visit to physician
List of Graphs
Table No Particulars Page
No

3.1 Up –to- date information

3.2 Usefulness of information

3.3 Reliability of information

4
Factor physician consider when prescribing
4.A
Consideration of clinical knowledge

4.B Consideration of peer reviewed journal


4.C Consideration of clinical practice guidelines
4.D Consideration of colleagues and peer
4.E Consideration of patient financial status
4.F Consideration of pharmaceutical company representative

4.G Consideration of patient personal opinion

5.0
Maximum impact of Rx behaviours

6 Physician value the work of pharmaceutical company


representative

6.A Drug Interaction

6.B Latest drug and treatment

6.C Assistance programme for prescription coverage

6.D Free drug sample

Presentation for physician and staff


6.E

6.F Reports of side effect

7.0 Effective component of detailing

8.0
M.R repetitive visit to physician
Executive summary

The pharmaceutical industry spends more funds on drug detailing than on any other
marketing instrument. Similar to the effect of advertising, the impact of detailing ex-
penditures spills over beyond the current period. Although the pharmaceutical industry is
mainly driven by innovation, it spends an enormous amount of funds on marketing. Indeed,
for the top 10 pharmaceutical companies, selling, general, and administrative expenses ranks
above research and development spend as the largest single expense. Among various
marketing resources expended, detailing - personal selling through representatives - together
with related sample distribution is the single largest expenditure. In 2008, the Indian
pharmaceutical industry spent Rs7.13 mn on detailing, together with Rs13.04 mn on samples,
which is far more than expenditures on other marketing instruments, e.g., Rs3.23 mn on
direct-to-consumer advertising and Rs0.48 mn on medical journal advertising (IMS Health
2004). Previous studies have shown a positive effect of detailing on physicians' prescription
behaviour.

The focus of our study is to assess the magnitude of physician responsiveness to


pharmaceutical marketing practices. Often, MRs will also dispense samples and possibly
offer small gifts to the physician. At issue is whether these interactions with MRs
compromise physician integrity and affect their prescribing behaviour.

The interaction between physicians and the pharmaceutical industry has become a subject of
increased interest and concern. This study surveyed a sample of physician practicing in and
around Udupi -Manipal region. It specifically focuses on the effectiveness of these
representatives of the manufacturers on physicians.
CHAPTER -1
1.1 INTRODUCTION

Pharmaceutical marketing has traditionally relied on a foundation of healthy interaction


between the detail representative and the physician. In recent years, however, there has been
well-documented erosion in the power of face-to-face detailing to drive prescriptions. By
confronting this situation, pharmaceutical companies can begin to reverse this trend.

The detailing could be Parma’s most powerful sales tool. Used to assist in communicating a
product's features and benefits to physicians, the detailing is a sales aid that reps carry along
on their sales calls—and an opportunity for marketers to influence physicians' prescribing
behaviour. Yet, the development of this critical sales tool often is handled with less rigor than
one might expect. Only one out of every three sales reps actually uses the detail piece during
a physician meeting. Often, sales teams don't use the piece because they don't have
confidence in the work done by marketing in developing it. Marketing counters that reps
simply don't know how to use it. This disconnect causes a considerable loss of energy, creates
a vicious cycle of blame, and places the performance of the brand—and therefore the
company—at great risk.

For sales reps to believe in the value of the detailing, they need to see evidence that it's
working. Currently, neither marketing nor sales tests the detail piece rigorously enough prior
to introduction. While the typical brand invests more than $100 million in annual sales-force
support, it spends less than $2 million on average to determine whether the detail piece is
driving prescriptions. Some companies altogether fail to test the effectiveness of the detail
piece during development because of limited budgets or time constraints. (Most pharma
companies operate on a pre-determined promotion cycle that only allows for new detail
pieces anywhere from two to four times per year.) Instead, companies often will settle for
qualitative feedback among the same, small physician panel. This approach not only lacks
statistical rigor, but also could lead to biased results that are not representative of the
marketplace.
1.2 NEED OF STUDY
The pharmaceutical industry spends more funds on drug detailing than on any other
marketing instrument. Similar to the effect of advertising, the impact of detailing ex-
penditures spills over beyond the current period. Although the pharmaceutical industry is
mainly driven by innovation, it spends an enormous amount of funds on marketing. Indeed,
for the top 10 pharmaceutical companies, selling, general, and administrative expenses ranks
above research and development spend as the largest single expense. Among various
marketing resources expended, detailing - personal selling through representatives - together
with related sample distribution is the single largest expenditure. In 2008, the Indian
pharmaceutical industry spent Rs7.13 mn on detailing, together with Rs13.04 mn on samples,
which is far more than expenditures on other marketing instruments, e.g., Rs3.23 mn on
direct-to-consumer advertising and Rs0.48 mn on medical journal advertising (IMS Health
2004). Previous studies have shown a positive effect of detailing on physicians' prescription
behaviour.

The focus of our study is to assess the magnitude of physician responsiveness to


pharmaceutical marketing practices. As the cost of prescription drugs continues to
escalate, increased public attention is being focused on the marketing practices of the
pharmaceutical firms as one source of the problem. Direct-to-physician activities account for
the bulk of pharmaceutical firm promotional spending. A detailing visit typically lasts two to
five minutes during which time a MR discusses one to three of the company’s drugs.
Information (and, at times, misinformation) about a drug’s composition, therapeutic value,
proper dosage, and potential side effects is communicated (Zigler et al. 1995). Often, MRs
will also dispense samples and possibly offer small gifts to the physician. At issue is
whether these interactions with MRs compromise physician integrity and affect their
prescribing behaviour.

The interaction between physicians and the pharmaceutical industry has become a subject of
increased interest and concern. This study surveyed a sample of physician practicing in and
around udupi -manipal region. It specifically focuses on the effectiveness of these
representatives of the manufacturers on physicians.
1.3Literature review
A recent survey from company Gemini Earnst and young highlighted the strain on some of
the relationship within the pharmaceutical sector, including those between sale representative
and the physician they target. A staggering 65%of surveyed physician expressed concern
about the message they send to patients. Pharmaceutical companies feel strongly about this
restricted access to the market ,with detailing times being reduced to as little as 30s

Personal digital assistance used in pharmaceutical detailing continue to incorporate new


functionally such as mobile communication ,wireless connectivity and medical
references.PDA used in pharmaceutical detailing are vital part of pharmaceutical
communication force automation system which in term is an important part of the CRM
system

Manchanda and Honka(2005)summarise that detailing has a strong and lasting positive effect
on physician prescribing behaviour.

Effect of detailing persists and takes this carry over effect in to consideration in their
detailing process

Detailing exhibit diminishing marginal effect and supersaturating effect.

Based on the pooled time series cross sectional data involving 3 drugs ,24 monthly
observation and 74,075individual physician in total. Support that detailing and free samples
have positive and statistically significant effect on the number of new prescription issued by a
physician. However we find that the magnitudes of the effect are modest

Marketing and promotional effects have helped raise physician awareness of the most recent
clinical practice guidelines

A 2007 physician surveyed by the tuft centre for the study of drug development, asked to
identify factors very imp in prescribing decision CME(67%) information from peers
(43%)and payers decision(13%) ought weighted information pharmaceutical
representative(13%).

Pharmaceutical marketing is far from the sale source of information for physician it plays an
important role in providing information for physician ,it plays an important role in providing
information about brand medicines and helps balance other factors that emphasize promoting
older treatment and that reduce use of needed medicines

Pharmaceutical marketing has traditionally relied on a foundation of health interaction


between the rep and physician. In recent years however there has been well documented
erosion in the power of face to face detailing to drive prescription. By confronting this
situation pharmaceutical companies can begin to reverse this trend.
2.1-TITLE OF THE PROJECT

TO STUDY THE EFFECTIVENESS OF


PHARMACEUTICAL DETAILING ON THE
PRESCRIBING HABIT OF PHYSICIANS
2.2-Objectives of Research:

1- To find out the component of detailing which has maximum impact on prescribing
behaviour of physician.

2- To study the impact of repetitive detailing on physicians.

3- To find out the relation between brand image of the company and ease of detailing.
2.3-Limitation of the study:

The major limitations of the study include:

 The sample size was 200 because of the difficulty in conducting the interviews with
respondents in given time frame.
 Sometimes respondents have varied views, personal bias cannot be overruled.

 Applicable only to udupi and manipal region so generalization is not possible

 Time constant,

2.4-Research methodology:
A successful completion of any project and getting genuine results from that depends upon
the method used by the researcher. The plan or the methodology for this study is laid upon
the following basis:
Research Design:
Sources of data collection
Research Approach
Sampling plan
1. Framework of the population
2. Sampling procedure
3. Sampling unit
4. Sampling size
Research Design: The research design for this research is descriptive.
Data sources
Two types of data viz., Primary and Secondary.
 Primary -.Questionnaires method, Personal Interview method.
 Secondary-Research articles, internet magazines, journals.
Research approach:

The approaches mainly opted by the researcher to get the results include behavioral, survey,
focus group, observational etc.

For conducting this research the basic approach used:

Questionnaire Method: The questionnaire used in the study for the purpose of data
collection was of structured type. The questionnaire was designed keeping in mind the
research problem, which included both open and closed ended questions

Sampling plan:
 Target population: All physician of Udupi and Manipal region.
 Sampling method: In this research study non – probability convenience sampling is
opted for. Convenience sampling is done purely on the basis of convenience or
accessibility. This sampling method has been mainly chosen because of time,
financial constraints as well as lack of expertise.
 Sampling unit: Single physician
 Sample size: A sample size of 200 was taken.

Statistical tools:
Classification and Tabulation transforms the raw data collected through questionnaires and
personal interviews into useful information by organizing and compiling the bits of data
contained in each of the 200 questionnaires and responses are converted into understandable
and orderly statistics for further analysis and interpretation.
Following applications of statistics are used to organize and analyze the data:
 Simple tabulation of data using tally marks.
 Calculating the percentage of the responses.
Formula used:
Percentage= (Number of responses/Total responses)*100
Graphical analysis by means of pie charts, bar graphs etc.
CHAPTER 3
3.1-DATA ANALYSIS:

1) Up-to-date of information from pharmaceutical representative

Table3.1)

Parameter Responses Percentage

Strongly agree 112 56

Somewhat agree 82 41

Somewhat disagree 6 3

Strongly disagree 0 0

60

50

40 Strongly agree
30 Somewhat agree
Somewhat disagree
20
Strongly disagree
10

0
Percentage

FIG-3.1

Interpretation: from this figure most of the physician agree about up-to-date information,
strongly disagree percentage is zero
2) usefulness of information from pharmaceutical company representative

(Table no-3.2)

Parameter Responses Percentage

Strongly agree 66 33

Somewhat agree 126 63

Somewhat disagree 6 3

Strongly disagree 0 0

70
60
50
Strongly agree
40
Somewhat agree
30 Somewhat disagree
20 Strongly disagree
10
0
Percentage

FIG-3.2

Interpretation: from this figure usefulness of information mostly is somewhat agree.


3) Reliability of information from pharmaceutical company representative

(Table no-3.3)

Parameter Responses Percentage

Strongly agree 56 28

Somewhat agree 124 62

Somewhat disagree 14 7

Strongly disagree 4 2

70
60

50
Strongly agree
40
Somewhat agree
30 Somewhat disagree
20 Strongly disagree

10
0
Percentage

FIG-3.3

Interpretation:from fig 3.3 most of the physician are somewhat agree about Reliability of
information from pharmaceutical company representative

4) Factor physician consider when prescribing

A) Consideration of clinical knowledge

(Table no-4.A)
Parameter Responses Percentage

Great deal 184 92

Some 14 7

Not at all 2 1

100

80

60 Great deal
Some
40 Not at all

20

0
Percentage

FIG-4.A

Interpretation: from fig 4.A mostly accept about Consideration of clinical knowledge and it
has great deal in prescribing

B) Considerations of Peer Reviewed Journal

Table 4.B)
Parameter Responses Percentage

Great deal 126 53

Some 82 41

Not at all 12 12

60

50

40
Great deal
30 Some
20 Not at all

10

0
Percentage

FIG-4.B

Interpretation: from fig 4.B Considerations of Peer Reviewed Journal has great deal
C) Consideration of clinical practice guidelines

Table 4.C)

Parameter Responses Percentage

Great deal 86 43

Some 94 47

Not at all 20 10

50

40

30 Great deal
Some
20
Not at all
10

0
Percentage

FIG-4.C

Interpretation: from fig 4.C Most of the physicians have some effect of clinical guidelines
in prescribing
D) Consideration of Colleagues and Peer

Table 4.D)

Parameter Responses Percentage

Great deal 74 37

Some 104 52

Not at all 22 11

60
50

40
Great deal
30 Some
20 Not at all
10

0
Percentage

FIG-4.D

Interpretation: Consideration of Colleagues and Peer has some effect on prescribing


E) Consideration of patient financial status

Table 4.E)

Parameter Responses Percentage

Great deal 80 40

Some 92 46

Not at all 28 14

50

40

30 Great deal
Some
20
Not at all
10

0
Percentage

FIG-4.E

Interpretation: Consideration of patient financial status has great effect in prescribing


F) Consideration from pharmaceutical company representative

Table 4.F)

Parameter Responses Percentage

Great deal 22 11

Some 126 63

Not at all 52 26

70
60
50
40 Great deal
30 Some
Not at all
20
10
0
Percentage

FIG-4.F

Interpretation: Consideration from pharmaceutical company representative has some effect.


G) Consideration of Patient Personal Opinion

Table 4.G)

Parameter Responses Percentage

Great deal 34 17

Some 110 55

Not at all 56 28

60
50

40
Great deal
30 Some
20 Not at all

10
0
Percentage

FIG-4.G

Interpretation: from fig 4.G Consideration of Patient Personal Opinion has some effect
Q5) Maximum Impact of Rx Behaviors

Table-5)

Parameter Responses Percentage

Brand image 140 70

Comments from peer 40 20

Prior work experience 16 8

Thoroughness of drug 4 2

70
60
50
Brand image
40
Comments frompeer
30 Prior work experience
20 Thoroughness of drug
10
0
Percentage

FIG-5.O

Interpretation: from fig 5.0 Brand image has maximum impact on Rx behaviors
6) Physician value the work of pharmaceutical representative

A) About drug interaction

Table 6.A)

Parameter Responses Percentage

Always Useful 106 53

Often Useful 42 21

Somewhat useful 42 21

Not useful 10 5

60

50
40 AlwaysUseful
30 OftenUseful
Somewhat useful
20
Not useful
10

0
Percentage

FIG-6.A

Interpretation: About drug interaction 53 percent accept it is always useful


B) Latest Drugs and Treatment

Table 6.B)

Parameter Responses Percentage

Always Useful 70 35

Often Useful 50 25

Somewhat useful 70 35

Not useful 10 5

35
30
25
AlwaysUseful
20
Often Useful
15 Somewhat useful
10 Not useful
5
0
Percentage

FIG-6.B

Interpretation: About latest drug and treatment mostly accept it is always useful
C) About Assistance Programs for Prescription Coverage

Table 6.C)

Parameter Responses Percentage

Always Useful 92 46

Often Useful 32 16

Somewhat useful 56 28

Not useful 20 10

50

40

30 AlwaysUseful
Often Useful
20 Somewhat useful
Not useful
10

0
Percentage

FIG-6.C

Interpretation: About Assistance Programs for Prescription Coverage mostly accept that it
is always useful
D) Provide Free Drug Sample

Table 6.D)

Parameter Responses Percentage

Always Useful 104 52

Often Useful 34 17

Somewhat useful 40 20

Not useful 22 11

60

50

40 AlwaysUseful
30 Often Useful
Somewhat useful
20
Not useful
10

0
Percentage

FIG-6.D
E) Informational Presentation for Physician and Staff

Table 6 .E)

Parameter Responses Percentage

Always Useful 46 23

Often Useful 46 23

Somewhat useful 84 42

Not useful 24 12

50

40
Always Useful
30
Often Useful
20 Somewhat useful
Not useful
10

0
Percentage

FIG-6.E

Interpretation: Informational Presentation for Physician and Staff is somewhat useful


F) Reports of side effect

Table 6.F)

Parameter Responses Percentage

Always Useful 72 36

Often Useful 34 17

Somewhat useful 48 24

Not useful 46 23

40
35
30
25 AlwaysUseful
20 OftenUseful
15 Somewhat useful
10 Not useful
5
0
Percentage

FIG-6.F

Interpretation: from fig6.f Reports of side effect is always useful

Q 7) Most effective component of detailing


Table 7.0)

Attribute Responses Percentage

Visual aids 72 36

Physician sample 34 17

Company news letter 48 24

M.R communication 46 23
skill

40
35
30
25 Visual aids
20 Physiciansample
15 Companynewsletter
10 M.Rcommunicationskill
5
0
Percentage

FIG-7.0

Interpretation: from fig7.0 most effective component of detailing is visual aids

8) Effect of M.R repetitive visit to physician


Table 8.0)

Parameter Responses Percentage

Positive effect 140 70

Negative 30 15

No consideration 20 10

70
60
50
40 Positive effect
30 Negative

20 No consideration

10
0
Percentage

FIG-8.0

Interpretation: from fig 8.0 repetitive visit of M.R has positive effect
CHAPTER -4
Findings
 Pharmaceutical representative provide them information about new studies and
clinical data, new dosing information and update on safety and risk information

 Value in representative answering their specific question and relaying reports of side
effect and other experimental information

 Most effective component of detailing is visual aids ,after that companies news letter
and M.R communication skill

 M.R repetitive visit to physician has positive effect on prescribing behavior

 Repeat visit of M.R is useful mainly in brand recall, knowing recent advances and
about other similar product

 Patient personal opinion have little effect in prescribing, and clinical knowledge, peer-
reviewed journals have great impact on prescribing
CHAPTER-5
Suggestion

 Apart from visual aids pharmaceutical company can improve effective detailing by
modern technology using internet, video conferencing

 Financial status of patient should be considered

 Reliability of pharmaceutical company representative information should be improved


by brand building of small company also

 Pharmaceutical company representative should follow clinical practice guidelines

 Company should give more attention on latest drug and treatment while in detailing

 There is need of improving social status of medical representative

 Medical representative should bridge the communication gap and information gap
CHAPTER-6
Conclusion
Pharmaceutical marketing and promotion provides
value to physicians by providing FDA-regulated
educational and scientific information about new
medicines. However, marketing of new medicines by
pharmaceutical companies is only one factor considered
by physicians. This marketing does not exist in a
vacuum—physicians’ judgment and experience, many
other sources of information, formularies and other
utilization management techniques all play a large role
in determining what, if any, medicine a patient receives.
While pharmaceutical marketing is far from the sole
source of information for physicians, it plays an
important role in providing information about brand
medicines and helps balance other factors that
emphasize promoting older treatments and that reduce
use of needed medicines.
Bibliography
1- Kong et al(2006), International journal of medical marketing, volume 4,page 138-140

2-(2007)Journal of computer information system, volume 6, issue no 8, page no 32,38

3- Dong et al,2006,british medical journal,volume 2,issue 190,page no 125-128

4-Mizik and Jacobson, 2003, management science, page no 1704-1715

5- Cutler ,david ,Harvard economics,page 420-427

6- Elliott C: The drug pushers. Atlantic Monthly Apr 2006, pp 82–93

7- IMS Medicare Watch, February 11, 2008

8- Dana J, Lowenstein G: A social science perspective on gifts to physicians from


industry. JAMA 290:252–255, 2003

9-IMS Press Release, “IMS Reports U.S. Prescription Sales Grew 3.8 Percent in

2007, to $286.5 Billion,” March 12, 2008.

10-J. Ma, “National Trends in Statin Use by Coronary Heart Disease Risk Category,”

Public Library of Science-Medicine, May 2005.


Questionnaires

Q1) Inform at ion from pharmaceutical company reps is


Up-to-date
a) Strongly disagree b) Somewhat disagree

b) Somewhat agree d) Strongly agree

Q2) Information from pharmaceutical company reps is useful

a) Strongly disagree b)Somewhat disagree

c) Somewhat agree d) somewhat agree

Q3) Information from pharmaceutical company reps is reliable

a) Strongly disagree b) somewhat disagree

c) Somewhat agree d) Strongly agree

Q4) Factors physicians consider when prescribing


A} Clinical knowledge
A) Great deal b) some d) not at all

B} Peer-reviewed journals

A) Great deal b) some d) not at all

C} Clinical practice guidelines

A) Great deal b) some d) not at all

D} Colleagues & peer

A) Great deal b) some d) not at all

E} Patient’s financial status

A) Great deal b) some d) not at all


F} Information from pharmaceutical co. Reps

a) Great deal b) some d) not at all

G} Patient’s personal opinions

a) Great deal b) some d) not at all

Q5) which is having the max impact on the Rx behaviour

a) Brand image b) comments from pear

c) Thoroughness of drug d) prior work experience

Q6) Physicians value the work of pharmaceutical company representatives

A) Provide information about drug interactions

a) always useful b)often useful


b) somewhat useful c) not useful

B} Provide information about the latest drugs and treatments

a) always useful b)often useful


b) somewhat useful c) not useful

C} Provide information about assistance programs for prescription coverage

a) always useful b)often useful


b) somewhat useful c) not useful

D} Provide free drug samples

a) Always useful b)Often useful


b) Somewhat useful c) Not useful

E} Provide informational presentations for physicians and staff

a) Always useful b) Often useful


c) Somewhat useful c) Not useful

F} Relay your reports of any side effects

a) Always useful b) Often useful


b) Somewhat useful c) Not useful
Q7) Most effective component of detailing

a) Visual aids b) Physician sample


c) Company news letter d) Mr. Communication skill

Q8) M.R Visiting repetitively causes

a) Positive attitude towards the brand b) negative attitude towards the brand
c) No consideration d) both

9) Repeat visit of M.R is useful in

a) Brand recall b) gaining up-to-date knowledge


c) Knowing about recent advances d) knowledge about other similar product

Profile of
Respondent:
Name:
____________________________

Address:
___________________

Contact No.:________________________

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