Although many studies have probed the link between direct-to-consumer drug advertising and physician and/or consumer behaviors, few have directly assessed whether such ads are associated with under- or overprescribing by physicians.
Now, a new study involving 152 family physicians and general internists suggests there may well be such a tie.
According to the study published in the April 27 Journal of the American Medical Association, DTC ads appear to have competing effects -- averting prescription drug underuse in certain settings and promoting overuse in others.
To be sure, the study's authors noted, patients' requests for specific drugs had "a profound effect" on the prescribing patterns of physicians in the study.
Family physicians Ronald Epstein, M.D., of Rochester, N.Y., and Peter Franks, M.D., of Vacaville, Calif., were among authors of the study.
To address four research questions, the randomized controlled trial used standardized patients mimicking symptoms consistent with either major depression or adjustment disorder with depressed mood. The questions:
- What are the effects of patients' requests for antidepressants on physician prescribing?
- Is there a difference in physician reaction when such requests are brand-specific (as might occur when a patient watches a consumer-targeted drug ad) versus more general in nature (as might occur if the patient saw a TV program on depression)?
- Do the effects of patients' requests vary based on the clinical indications for antidepressant therapy?
- What are the effects of brand-specific and general requests on other depression care indicators?
Physicians recruited for the study were told that standardized patients would be used to help researchers "assess social influences on practice and the competing demands of primary care." Overall, the researchers found, standardized patient role fidelity was excellent, with only 13 percent of physicians in the study suspecting they had seen a standardized patient.
Among the study's key findings: For standardized patients presenting with symptoms of major depression, physicians prescribed antidepressants 53 percent, 76 percent and 31 percent of the time for those who made brand-specific, general and no requests, respectively. For those mimicking adjustment disorder symptoms, antidepressant prescribing rates were 55 percent, 39 percent and 10 percent, respectively.
Minimally acceptable initial care (any combination of an antidepressant, mental health referral or primary care follow-up within two weeks) was offered to 98 percent of patients in the major depression role who made a general request, 90 percent of those who made a brand-specific request and 56 percent of those who made no request.
