Few Patients Request Advertised Prescription Drugs | Arthritis Information

In only 3.5% of encounters did the patient ask about a specific new prescription medication, Bennett Parnes, M.D., of the University of Colorado School of Medicine here, and colleagues reported in the January/February issue of the Annals of Family Medicine.

Clinicians rated the impact of a patient's request for a specific drug as positive in 24.1% of visits, neutral in 65.5%, and negative in just 10.3%.

A study conducted five years earlier found that patients requested a specific prescription medication in 15.8% of encounters.

The lower rate in the current study might be explained by the high number of low-income patients, who might avoid asking for advertised prescription medications because of the high cost, and the large proportion of Hispanic patients, many of whom speak only Spanish and therefore have decreased exposure to advertising, the researchers said.

But the findings might also reflect the declining influence of the growing practice of direct-to-consumer advertising, which exposes the average American to 100 minutes of televised ads for each minute of time spent with a physician, they said.

"Patients may be less trusting of the pharmaceutical industry than before," the researchers said.

Dr. Parnes and colleagues wanted to examine whether enhanced scrutiny of direct-to-consumer advertising in recent years affected the practice's impact on physician-patient encounters.

So they conducted a cross-sectional survey of clinicians in the State Networks of Colorado Ambulatory Practices and Partners, which includes urban and suburban practices caring for underserved populations, rural practices and healthcare facilities, and private practices.

The current study included 1,647 patient encounters at eight federally qualified community health centers, five family medicine residency sites, and nine private practices.

For a half or full day, 168 clinicians completed a form after each patient encounter to record any inquiries about specific prescription drugs.

More than three-quarters (76.2%) identified their specialty as family medicine, 12.5% as internal medicine, 5.4% as pediatrics, and 2.4% as another specialty.

One-fifth (20.2%) of clinicians were physician assistants or nurse practitioners and 29.2% were residents.

Patients (mean age 38.2; 43.6% Hispanic) asked specific questions in only 58 encounters (3.5%).

When the analysis was limited to medications that were advertised in recent years, the rate dropped to 2.6%.

Clinicians said that the patients had heard about the medication through the media or advertising 20.7% of the time and from family or friends 32.8% of the time, although "it was difficult to determine the extent to which medication inquiries were influenced by advertising," the researchers said.

In a multivariate analysis, positive predictors for asking about a prescription drug were:

• Patient taking at least three chronic medications (OR 2.25, 95% CI 1.40 to 3.62, P=0.001)
• Encounter at a private practice instead of a community health center (OR 3.10, 95% CI 1.28 to 7.47, P=0.025)
• The clinician being female (OR 2.68, 95% CI 1.33 to 5.41, P=0.025)

Clinicians said that in 62.1% of the encounters that included an inquiry about a drug, the requested medication was not their first choice for treatment.

However, the requested drug was prescribed 53.5% of the time, despite the fact that 65.5% of the clinicians said they did not feel pressured to do so.

Future studies should explore this phenomenon, the researchers said.

Positive effects of the inquiry cited by clinicians included the facilitation of discussion, patient education, improved condition awareness, and the identification of new conditions.

The patient inquiry was reported to increase visit time by 37.9% of clinicians.

The researchers said that the rate of medication requests in the current study may be lower because the patients had already asked about specific drugs in previous visits.

"Alternatively," they said, "the lower rate of medication inquiry may reflect recent industry strategies focused on promoting diseases and symptoms (which was not measured in this study), rather than specific medications."

The authors noted that the study was limited by potential selection bias, the limited generalizability to other populations, and the lack of information in the total number of patients seen by clinicians during the study period.