COMMENTARY

The Satisfied Patient: Overprescribed and Costly

Charles P. Vega, MD

Disclosures

April 30, 2010

Patient Satisfaction and Outcomes: An Introduction

Patient satisfaction is an important outcome of healthcare delivery, and patient requests for products or services factor into the equation that produces satisfaction. Research demonstrates that physicians may be too open to requests for specific medications. In a 2000 study, the satisfaction scores of 200 patients were correlated with disease outcome variables, and patient-centered care was associated with lower rates of death and in-hospital complications.[1] However, patient-centered care was also associated with higher healthcare costs. This review focuses on a 2010 study by Paterniti and colleagues[2] that revealed surprising prescribing patterns, based on standardized patients' request for treatment. The researchers also analyzed physicians' responses to these requests and offers strategies to improve patient satisfaction while practicing evidence-based medicine.[2]

Communication is at the heart of patient-centered care, but requests for specific tests or treatments can strain the dialogue between physician and patient. In a study of 887 patients, 84% reported making at least 1 request during their office visit with a physician.[3] Approximately 80% of these requests were granted, and acquiescence to these requests improved patients' perceptions of their care. Of note, patients who had their requests fulfilled experienced fewer symptoms and health concerns at follow-up, but denial of patient requests did not change post-visit outcomes. In another study of patient and clinician behaviors, patient requests for specialty referrals increased the odds of referral by more than 4 times, and prescription requests increased the odds of getting a prescription nearly 3-fold.[4] Physicians noted that visits with patients were more demanding when patients requested diagnostic tests.

The issue of patient requests for medications is particularly sensitive in this era of direct-to-consumer advertising for prescription drugs. A study compared rates of requests for specific prescription drugs in the United States, where pharmaceutical advertising is legal, with those in Canada, where it is not.[5] Patients in the United States were more than twice as likely to request specific pharmaceutical agents, and patients who reported greater exposure to prescription drug advertising were more likely to request these medications.

How did physicians respond to these requests? They were nearly 17 times more likely to prescribe new medications to patients who made a request for an advertised medication, even though many physicians made it clear that they would not use these same advertised prescriptions for other patients with similar diagnoses.

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