Direct-to-consumer Prescription Drug Advertising and Patient-Provider Interactions

Helen W. Sullivan, PhD, MPH; Kathryn J. Aikin, PhD; Jennifer Berktold, PhD; Karen L. Stein, PhD; Victoria J. Hoverman, PhD

Disclosures

J Am Board Fam Med. 2020;33(2):279-283. 

In This Article

Abstract and Introduction

Abstract

Background: Direct-to-consumer prescription drug advertising is prevalent and affects patient care. Previous research that examined its effect on the patient-provider relationship predates many changes in the advertising and medical landscape that have occurred in the last decade, such as the rise in online promotion and the push for value-based medicine.

Methods: We conducted a nationally representative mail-push-to-web survey of 1744 US adults in 2017 to explore how patients view the effects of direct-to-consumer prescription drug advertising on patient-provider interactions.

Results: Most respondents (76%) said they were likely to ask a health care provider about advertised drugs; 26% said they had already done so. Among the 26% of respondents who talked to a health care provider about a specific prescription drug they saw advertised, 16% said they received a prescription for the advertised drug. Few respondents (5%) reported that advertising had caused conflict with a health care provider, 16% said it had caused them to question their provider's advice, and 23% said they were likely to look for a different provider if their provider refused to prescribe a requested brand name drug.

Discussion: These results suggest that direct-to-consumer advertising is driving some patients to discuss specific products with their health care providers but that most patients do not believe advertising has a negative influence on the patient-provider interaction itself.

Introduction

Direct-to-consumer advertising of prescription drugs (DTCA) is prevalent in the United States, with the amount spent on this advertising rising into the billions of dollars per year.[1] This advertising is known to affect patient care.[2] For instance, recent studies have found that DTCA increased the use of antidepressants,[3] testosterone testing and use,[4] high-cholesterol diagnosis and statin use in low-risk patients,[5] prescribing of a smoking cessation product before safety issues were identified,[6] and asthma medication prescription sales and asthma-related emergency room visits.[7] A recent systematic review of the literature on the effects of DTCA on patient-provider interactions[8] identified both potential benefits, such as patients feeling more confident in their discussions with providers,[9] and potential harms, such as patients reporting that DTCA led them to request prescription drugs.[10] A limitation of this review is that most of the included studies were more than a decade old. As an example, the US Food and Drug Administration, which oversees DTCA to ensure it is truthful, balanced, and accurately communicated,[11] last surveyed patients about the influence of DTCA on their interactions with health care providers (HCPs) in 2002.[12] Declines in print readership, the rise in online promotion, and Pharmaceutical Research and Manufacturers of America guidelines have greatly altered DTCA in the last decade. Given the continued debate over DTCA,[13] we examined how it currently affects patient-provider interactions from a patient perspective.

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