Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants: A Randomized Controlled Trial
Richard L. Kravitz,Ronald M. Epstein,Mitchell D. Feldman,Carol E. Franz,Rahman Azari,Michael S Wilkes,W Ladson Hinton,Peter Franks +7 more
TLDR
Patients' requests have a profound effect on physician prescribing in major depression and adjustment disorder, and direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.Abstract:
ContextDirect-to-consumer (DTC) advertising of prescription drugs in the United
States is both ubiquitous and controversial. Critics charge that it leads
to overprescribing, while proponents counter that it helps avert underuse
of effective treatments, especially for conditions that are poorly recognized
or stigmatized.ObjectiveTo ascertain the effects of patients’ DTC-related requests on
physicians’ initial treatment decisions in patients with depressive
symptoms.DesignRandomized trial using standardized patients (SPs). Six SP roles were
created by crossing 2 conditions (major depression or adjustment disorder
with depressed mood) with 3 request types (brand-specific, general, or none).SettingOffices of primary care physicians in Sacramento, Calif; San Francisco,
Calif; and Rochester, NY, between May 2003 and May 2004.ParticipantsOne hundred fifty-two family physicians and general internists recruited
from solo and group practices and health maintenance organizations; cooperation
rates ranged from 53% to 61%.InterventionsThe SPs were randomly assigned to make 298 unannounced visits, with
assignments constrained so physicians saw 1 SP with major depression and 1
with adjustment disorder. The SPs made a brand-specific drug request, a general
drug request, or no request (control condition) in approximately one third
of visits.Main Outcome MeasuresData on prescribing, mental health referral, and primary care follow-up
obtained from SP written reports, visit audiorecordings, chart review, and
analysis of written prescriptions and drug samples. The effects of request
type on prescribing were evaluated using contingency tables and confirmed
in generalized linear mixed models that accounted for clustering and adjusted
for site, physician, and visit characteristics.ResultsStandardized patient role fidelity was excellent, and the suspicion
rate that physicians had seen an SP was 13%. In major depression, rates of
antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific,
general, and no requests, respectively (P<.001).
In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and
10%, respectively (P<.001). The results were confirmed
in multivariate models. Minimally acceptable initial care (any combination
of an antidepressant, mental health referral, or follow-up within 2 weeks)
was offered to 98% of SPs in the major depression role making a general request,
90% of those making a brand-specific request, and 56% of those making no request
(P<.001).ConclusionsPatients’ requests have a profound effect on physician prescribing
in major depression and adjustment disorder. Direct-to-consumer advertising
may have competing effects on quality, potentially both averting underuse
and promoting overuse.read more
Citations
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Assessment in Medical Education
Malcolm Cox,David M. Irby +1 more
TL;DR: A conceptual framework for and a brief update on commonly used and emerging methods of assessment is provided, discusses the strengths and limitations of each method, and identifies several major challenges in assessing professional competence and performance.
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The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality
TL;DR: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
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Patient Participation: Current Knowledge and Applicability to Patient Safety
Yves Longtin,Hugo Sax,Lucian L. Leape,Lucian L. Leape,Susan E. Sheridan,Susan E. Sheridan,Liam Donaldson,Didier Pittet,Didier Pittet +8 more
TL;DR: A conceptual model including key factors that influence participation and invite patients to contribute to error prevention is proposed, and further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.
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A Decade of Direct-to-Consumer Advertising of Prescription Drugs
TL;DR: The findings suggest that calls for a moratorium on such advertising for new drugs would represent a dramatic departure from current practices, and spending on direct-to-consumer advertising has continued to increase in recent years in spite of the criticisms leveled against it.
References
More filters
Journal ArticleDOI
Approximate is Better than “Exact” for Interval Estimation of Binomial Proportions
Alan Agresti,Brent A. Coull +1 more
TL;DR: For example, this paper showed that using the adjusted Wald test with null rather than estimated standard error yields coverage probabilities close to nominal confidence levels, even for very small sample sizes, and that the 95% score interval has similar behavior as the adjusted-Wald interval obtained after adding two "successes" and two "failures" to the sample.
Book
Generalized, Linear, and Mixed Models
TL;DR: In this paper, the authors present a model for estimating the effect of random effects on a set of variables in a linear mixed model with the objective of finding the probability of a given variable having a given effect.
Journal ArticleDOI
Comparison of vignettes, standardized patients, and chart abstraction: A Prospective validation study of 3 methods for measuring quality
TL;DR: Vignettes appear to be a valid and comprehensive method that directly focuses on the process of care provided in actual clinical practice and show promise as an inexpensive case-mix adjusted method for measuring the quality of care given by a group of physicians.
Journal ArticleDOI
Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial.
Kenneth B. Wells,Cathy D. Sherbourne,Michael Schoenbaum,Naihua Duan,Lisa S. Meredith,Jürgen Unützer,Jeanne Miranda,Maureen F. Carney,Lisa V. Rubenstein +8 more
TL;DR: When managed primary care practices implemented QI programs that improve opportunities for depression treatment without mandating it, quality of care, mental health outcomes, and retention of employment of depressed patients improved over a year, while medical visits did not increase overall.