Article Figures & Data
Tables
Characteristic No. % Age, y (mean 38.2 ± 24.6 y; median 36 y) <1 59 3.6 1–18 335 20.3 19–49 647 39.3 50–64 286 17.4 ≥65 273 16.6 Missing 47 2.9 Sex Male 567 34.4 Female 1,076 65.4 Missing 4 0.2 Race/ethnicity White non-Hispanic 782 47.5 Black non-Hispanic 93 5.6 Hispanic 718 43.6 Other 34 2.1 Missing 20 1.2 No. of active medical problems 0 387 23.5 1–2 659 40.0 3–5 383 23.3 >5 193 11.7 Missing 25 1.5 No. of long-term prescription medications 0 627 38.1 1–2 446 27.1 3–5 287 17.4 >5 264 16.0 Missing 23 1.4 Patient pays entire cost of prescription medications Yes 203 12.3 No 1,183 71.8 Don’t know 159 9.7 Missing 102 6.2 - Table 2.
Patient (n = 1,647) and Physician (n = 168) Characteristics Associated With Requests for Medications
Characteristics ORa 95% CI P Value CI=confidence interval; OR = odds ratio. a Multivariate mixed logistic regression model. Patient Age, y <50 1 0.429 ≥50 1.21 0.75, 1.96 Race/ethnicity All others 1 0.051 White non-Hispanic 1.54 1.00, 2.38 Chronic medications 0–2 1 0.001 ≥3 2.25 1.40, 3.62 Clinician Sex Male 1 0.025 Female 2.68 1.33, 5.41 Clinic type (n = 22) Community health center 1 0.025 Residency 1.32 0.55, 3.14 Private 3.10 1.28, 7.47 Category Number Antimicrobial 7 Antidepressant 6 Gastrointestinal 5 Contraception 5 Dermatology 4 Hypnotic and/or benzodiazepine 4 Nonnarcotic pain medication 4 Cardiac: blood pressure and lipids 3 Hypnotic nonbenzodiazepine 3 Narcotic pain medication 3 Respiratory 2 Erectile dysfunction 2 Osteoporosis 2 Psychiatric (not listed above) 2 Steroids 2 Weight loss 1 Miscellaneous 7 Question No. % How did the patient hear about the medication? (note: multiple responses allowed) Family or friends 19 32.8 Media or advertising 12 20.7 Internet 2 3.5 Other source 21 36.2 Unknown 6 10.3 Did the patient understand the purpose of the medication? Yes 56 96.6 No 2 3.4 Would this requested medication have been the clinician’s first choice of treatment? Yes 12 20.7 No 36 62.1 No opinion 10 17.2 Did the patient want a prescription for the medication? Yes 43 74.1 No 15 25.9 Did the clinician feel pressured to prescribe the medication? Significant pressured 7 12.1 Somewhat pressured 13 22.4 Not pressured 38 65.5 Was the requested medication prescribed? Yes 31 53.5 No 27 46.5 What was the overall effect of the patient request on the visit? Positive 14 24.1 Neutral 38 65.5 Negative 6 10.3 Specific effects of the inquiry/discussion on the visit (multiple responses allowed) Facilitated discussion 33 55.1 Educated patient 28 48.3 Improved condition awareness 21 36.2 New conditions identified 6 10.3 Increased visit time 22 37.9 Raised insurance concerns 8 13.8 Negative impact on physician-patient relationship 3 5.2
Additional Files
Supplemental Appendixes 1-2
Supplemental Appendix 1. The Encounter Survey Instrument; Supplemental Appendix 2. The Clinician Information Form.
Files in this Data Supplement:
- Supplemental data: Appendixes 1-2 - PDF file, 3 pages, 162 KB
The Article in Brief
Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report
Bennett Parnes , and colleagues
Background Proponents of direct-to-consumer pharmaceutical advertising (DTCA) suggest it can inform consumers, motivate them to seek care, and help them weigh treatment options. Critics argue that DTCA provides incomplete and biased information, leads to inappropriate prescribing, and consumes time in the medical visit. This study examines the rate of patient medication inquires and their influence on primary care doctor visits.
What This Study Found In this study, patient inquiries for prescription medications were uncommon (3.5% of visits) and inquiries for advertised products were even lower (2.6%). Clinicians did not usually feel that these requests had a negative effect on the medical visit.
Implications
- The study included a large proportion of patients in lower income groups, who because of cost may be less inclined to request specific medications. Even among private practices in the study, however, the rate of medication inquiries was 7.2%, less than one-half the rate in a previous report.
- Patients and doctors may be growing accustomed to medication requests and DTCA.
- DTCA may have less effect on lower income groups.
