Perception of Promoting Activity in Romanian Supply Chain of Chemical Substances A complex statistical analysis

In the pharmaceutical production chain, the communication between pharmacies and medicine distributors are important. The aim of this research is to analyze–using complex statistical methods– the pharmacist’s perception of promoting activity in relation with medicine distributors in Brasov and Mures. Our results have implications in marketing communication in the pharmaceutical sector in Romania being a first study that demonstrated the importance of pharmacists in their double role between the qualitative side, of satisfaction, and quantitative side, of sales.

The pharmaceutical industry is one of the most spectacular industries worldwide in terms of sales and marketing [1]. The marketing used by the Romanian medicine distributors in relationship with pharmacies has a lot of particularities [2] including the promotion activity and sensitivity to prices from the consumer [3] a large amount of money is spent for purchasing medicinal items [4]. Regarding this aspect, the last Cegedim [5] report signaling an increasing value of medicines distributed to Romanian patients in March 2018 with 11.8% compared with previous year, the Romanian pharmaceutical products sector is mentioning on an ascending trajectory [6].
In the pharmaceutical production chain, the relation and communication between pharmacies and medicine distributors are very important; the occasional errors in this process can lead to end customer dissatisfaction [7]. Therefore, it is important to study/analyze the pharmacist's perception of promoting activity and aspects related to promotion because the pharmacists make the link between medicine distributors and final consumers, respectively patients. In this study we take into considerations a few aspects, detailed in Table 1. In the literature review, we find only one study regarding these aspects but from the medicine brand point of view [8] and using the final consumers not pharmacists. Another study in Romania [1] highlights another important particularity: Romanian companies are highly affected by defective upwards communication, which can generate wrong strategic approaches and ignorance in terms of market trends and competitors' strategies.
For pharmaceutical companies is important the loyalty to consumers' needs [9], the final consumers' access to pharmaceutical product remains essential [9], in modern pharmaceutical companies the current practice is that medical research is correlated with marketing research in selecting product characteristics that best suit patient needs [10].
The aim of this research is to analyzeusing complex statistical methods -the pharmacist's perception of promoting activity in relation with medicine distributors in two Romanian counties (Brasov and Mures). We mention that this paper is only a part from a complex research of the authors.

Experimental part Materials and methods
For this study we use 198 questionnaire (with 14 items) completed by the pharmacists from Mures and Brasov counties, both from hospital and retail, from 1 May to 15 July 2018. We used SPSS v17.0 soft for the complex statistical analysis, respectively: descriptive statistics (mean, median, standard deviation, minim and maxim); Pearson correlations to analyze the direction and intensity of associations between variables; Kolmogorov -Smirnov test to analyze the normal distribution of the responses; chi-square test to test which variables differentiate according to the degree of satisfaction of pharmacists in relation with drugs distributors; t Student test to test the differencies between means of items scores; Mann -Whitney test to test which of the items differentiate between the satisfied and unsatisfied pharmacist in relation with drugs distributors; linear regression analysis to find a model of satisfaction' degree of pharmacist according to variables of the study. The questions were accordance with the principles of pharmaceutical practice regulated in the Romanian Pharmaceutical Good Practice Rules [11]

Results and discussions
To analyze the central tendency of the variables, we applied descriptive statistics, respectively the mean, the median, minim and maxim values, and standard deviation ( Table 1). Data being qualitative, the results from Table 1 represent the values calculated based on codes of the response of each items in the study.

-mergers and acquisitions made at international level, 4-increased number of illnesses).
According to the means from table 1, we can observe that for variable C1, the pharmacists are satisfied by their collaborations with medicine distributors; the most effective way to promote medicine (C10) is the products/medicines exhibitions; it is a relevant to use medical representatives team to promote medicine in pharmacies (C11); the patients are influenced by the family doctor/specialist doctor/primary doctor (C12); the most important aspect, for patients, is that medicine to arrive quickly as possible (C13); the pharmacists explanation for the continuous growth of Romanian market is the mergers and acquisitions made at international level (C14).
Because to the first item of questionnaire (C1) there were differencies and also there were different opinions and appreciations to the other questions in the questionnaire, we applied the nonparametric statistic to deepen the interpretation of the data. Therefore, chi square test was applied with the null hypothesis: H0 = There are no statistically significant differences depending on the degree of satisfaction of the pharmacies regarding the relation with medicine distributors, related to all the other aspects of the study. The results are presented in Table 2 only for the items with pvalue <0.05. For the statistic value  2 calculated higher than  2 theoretically, H0 is rejected, concluding that (the last column of Table 2) there are differences depending on the degree of satisfaction only referring to aspect describing by C13. Also, for variable C10, because the H0 is accepted we can conclude that all the pharmacists from the sample consider that the most effective way to promote medicine is products/medicines exhibitions. To test if there are statistically significant differencies between the score averaged by the response of each item, mean of each answers the Student t test was applied, the results being shown in Table 3. http://www.revistadechimie.ro Because for each item the p-value < 0.05 (statistically significant for 100% of sample), results that, the scores averaged are statistically significant for all 6 item of the study. To establish if there are correlations between the variables of the study and to analyze both the direction and intensity of these correlations, we applied Pearson coefficients. The results are presented in Table 4. From the above data it can be noticed that there are positive (direct) correlations (marked with red in the table) and also negative (inverse) ones (marked with blue in the table), both statistically significant but of low intensity (Pearson coefficients  0,300). To test if the answers of each item are normal distributed (Gauss curve) we applied the Kolmogorov-Smirnov test, the results being presented in Table 5. The results show that for all 6 items the distribution is normal. Because the distributions of answers are normal for the items and because exist significant correlations between variables (items) we applied the linear regression model to analyse and to fiind a model for depending variable satisfaction degree of pharmacist -medicine deistributors relationship according to variables C10-C14. The results are presented in Tables 6-8. According to data from Table 6 and Table 7 we can conclude that the model are significantly statistic (p-value of ANOVA is 0.049) but the model explain only 23.6% of total variance (R coefficient = 0.236) that it mean the model are available only for this percept of sample.  From data of Table 8 we can observe that only for two variables the contribution to the model are statistically significant, respectively for C11 and C13, respectively the satisfaction degree of pharmacist in collaboration with medicine distributors are positively affected by the promotion activity made by medical representative teams (C11) and negatively by the most important aspects for medicine beneficiaries, respectively the medicine price to be lowest. This last aspect demonstrates the sensitivity of Romanian patients to the price of the medicine from the pharmacist's point of view and directly experience with clients.
In order to test for which of the 5 items (C10-C14) the degree of satisfaction of the pharmacies in the study is different, we divided the 198 pharmacies into two groups (satisfied (152) and dissatisfied (11)) and applied the Mann -Whitney test for two different samples to test the significance of these differences. The results are presented in Table 9. According to results presented in Table 9, it can observe that none of these five variables differentiate between the satisfied and unsatisfied pharmacists.

Conclusions
The statistically significant results of the research, even it was collected from only two Romanian counties (Brasov and Mures), can be inference at the national level.
Regarding the results from descriptive statistics for variable C14 (the fusions and acquisitions from international level influenced the growth or Romanian medicine market), our results confirm the last Cegedim report respectively that the top 10 medicine producers are dominated by the multinationals and international companies [5].
The our results of the chi-square test and the linear regression model (with only variables C11 and C13 significant statistically) confirm the international one, respectively that, for a better and effective service management in a pharmacy is need by a sustain steady in supply [4] and to upgrade the role of the modern pharmacies under a wide range of cognitive pharmaceutical services [12].
The present results highlights also another particularity of pharmacists' perception of promoting activity in Romanian supply chain: the international results [8] show that the final consumers are sensitive to the TV advertising and social responsibility but we find thatfrom the pharmacists point of viewthe final consumers a sensitive to the promotion made by the teams of medical representatives and they are influenced by their doctor (family doctor/specialist doctor/primary doctors). Our results confirm also the causal relationship between operational managers of pharmacies and users [13].
In conclusion, it is important, for pharmacists to have a pharmaceutical care practice in accordance with patients' needs but also to have more efficient communication with them [12].
The present results may have implications in marketing communication in the pharmaceutical sector in Romania being a first study that demonstrated the importance of pharmacists in their double role (in fact they represent the interface between patients and medicine distributors) and those establishing a relation between the qualitative side, of satisfaction, and quantitative side, of sales [14].