# Presentation: 692339

## DTC Advertising Physician Survey: GPs vs Specialists

- John Swasy
- American University
- Kathryn Aikin
- DDMAC, FDA
- DTC National, March 26, 2003
- Boston

## FDA Physician Survey

- Look more closely at impact of direct-to-consumer advertising (DTCA) on doctor-patient relationship

## 2002 Physician Survey: Methodology

- Random Sample from American Medical Association Physician Masterfile
- 250 General Practitioners
- 250 Specialists
- Dermatology
- Allergy/Pulmonology
- Endocrinology
- Psychiatry

## The GPs and Specialists were similar

Gender   (83% Male)
Years of practice  (22 yrs)
Time spent in direct patient care  
All had over 50% 
90% reported spending 75% or more of their time in direct patient care.
Number of patients per week (median:100 )
Number of prescriptions written per week (median: 100 )  

- Gender   (83% Male)
- Years of practice  (22 yrs)
- Time spent in direct patient care
- All had over 50%
*90% reported spending 75% or more of their time in direct patient care*.
- Number of patients per week (median:100 )
- Number of prescriptions written per week (median: 100 )

## Impact of DTC Advertising on Patient Interaction

## Now think about the most recent interaction you’ve had with a patient who initiated a discussion about a prescription drug and told you he or she saw it advertised.

- Can you think of a patient who initiated a discussion about a prescription drug they saw advertised?
- Yes		92%
- No		8%

- N = 500

## Beneficial Effects

- N = 459

- Did the fact that this patient saw an advertisement have any beneficial effects
- for your interaction with this patient?

## What beneficial effects did it have?

**GPs     SPs**

- N =   187

**51       55**

**38       45**

**  ****9       12**

** ****12        9**

** ****4        14**

** ****5         7**

** ****3         0**

** ****4         2**

**All physicians**

## Problems

- N = 459

- Did the fact that this patient saw an advertisement create any problems
- for your interaction with this patient?

## What problems did it cause?  

- Percent

**GPs     SPs**

- N =    82

**34       49**

**29       22**

**12        5**

** ****2         7**

** ****2         7**

** ****2         5**

** ****5         2**

** ****0         5**

**All physicians**

- What problems did it cause?

## Patient Rx Inquiries, Requests, and Perceived Pressure to Prescribe

## Brand Rx Inquiries and Condition

- Did the patient ***ask*** *about* a specific
- prescription drug by brand name?

- Did the patient have the
- condition the drug treats?

- Specialists

- GPs

- N = 229

- N = 223

## Brand Rx Inquiries and Condition

- Did the patient ***ask*** *about* a specific
- prescription drug by brand name?

- Specialists

- GPs

**DK**
**1**%

**No **
**13**%

**Yes**
**86**%

**Yes**
**87**%

**No **
**13**%

- N = 229

- N = 223

- Did the patient have the
- condition the drug treats?

## Brand Rx Inquiries and Condition

- Did the patient ***ask*** *about* a specific
- prescription drug by ***brand*** name?

- Specialists

- GPs

**DK**
**1**%

**No **
**13**%

**Yes**
**86**%

**Yes**
**87**%

**No **
**13**%

**Yes**
**87**%

**No **
**11**%

**DK**
**3**%

**Yes**
**89**%

**No **
**10**%

**DK**
**1**%

- N = 229

- N = 223

- Did the patient have the
- condition the drug treats?

- N = 198

- N = 192

## Rx Requests and Prescribing Behavior

- GPs

- N = 227

- Did the patient ask you *for* a prescription?

- Did you give the patient a
-  prescription at this visit?

- N = 232

## Rx Requests and Prescribing Behavior

- GPs

- N = 227

- Did the patient ask you *for* a prescription?

- Did you give the patient a
-  prescription at this visit?

- N = 232

**Yes**
**44**%

**No **
**56**%

**Yes**
**60**%

**No **
**39**%

**DK**
**1**%

-  N = 459    2 (1 df) = 11.5  p < .01

## Rx Requests and Prescribing Behavior

- GPs

- N = 227

- Did the patient ask you *for* a prescription?

- Did you give the patient a
-  prescription at this visit?

- N = 232

**Yes**
**44**%

**No **
**56**%

**Yes**
**60**%

**No **
**39**%

**DK**
**1**%

**No **
**23**%

**Yes**
**77**%

**Yes**
**74**%

**No **
**26**%

- N = 137

- N = 99

## Brand Rx Requests and Prescribing 

- GPs

- N = 165

- N = 194

- Brand Rx Requests and Prescribing

- Did the patient ask you *to* *prescribe* a specific brand name
- drug?

- Did you prescribe the brand
- name drug the patient asked for?

## Brand Rx Requests and Prescribing 

- GPs

- N = 165

- N = 194

- Brand Rx Requests and Prescribing

- Did the patient ask you *to* *prescribe* a specific ***brand*** name
- drug?

- Did you prescribe the brand
- name drug the patient asked for?

**No **
**35**%

**Yes**
**65**%

**No **
**48**%

**Yes**
**52**%

-  N = 359    2 (1 df) = 6.64  p < .05

## Brand Rx Requests and Prescribing 

- GPs

- N = 165

- N = 194

- N = 126

- N = 85

- Brand Rx Requests and Prescribing

- Did the patient ask you *to* *prescribe* a specific brand name
- drug?

- Did you prescribe the brand
- name drug the patient asked for?

**No **
**35**%

**Yes**
**65**%

**Yes**
**64**%

**No **
**36**%

**No **
**54**%

**Yes**
**46**%

**No **
**48**%

**Yes**
**52**%

-  N = 359    2 (1 df) = 6.64  p < .05

-  2 (1 df) = 7.01  p < .01   N = 211

## Reasons for not prescribing

**All physicians**

- Why didn’t you prescribe the drug the patient requested?			N = 98

## Reasons for not prescribing

**GPs     SPs**

**61       83**

**43       81**

**37       60**

**All physicians**

- Why didn’t you prescribe the drug the patient requested?			N = 98

**<**

**<**

**<**

## Reasons for not prescribing

**GPs     SPs**

**61       83**

**43       81**

**37       60**

**51       32**

**33       11**

**26       19**

**22         6**

**24         0**

**All physicians**

- Why didn’t you prescribe the drug the patient requested?			N = 98

**>**

**>**

**>**

**>**

**>**

**<**

**<**

**<**

## Patient Influence on Interaction

## Perceived Patient Influence

- Did the patient try to influence the course of treatment in a way that would have been
- harmful to him or her?						N = 459

## Perceived Pressure to Prescribe

- Percent

- To what extent did you feel pressured to prescribe a drug for the patient at this visit?
- 								N=459

-   2 (3 df) = 14.5  p < .01

## Attitudes About Potential Negative Effects of DTCA on Patients and Practice

## Problems DTCA Creates for My Patients and Practice... “Exaggerates Benefits”

- Confuses relative risks & benefits

- Think drugs work better than they really do

-  2 (3 df) =7.89 p < .05

-  2 (3 df) =6.22 , n s

- N=500

## Problems DTCA Creates for My Patients and Practice.. “Seek Advertised Drug”

- Want advertised drugs over any others

- Want advertised drugs over less expensive treatments

-  2 (3 df) = 12.10 p < .01

-  2 (3 df) = 17.08 ,p < .01

- N=500

## Problems DTCA Creates for My Patients and Practice.. “Seek Unnecessary Prescriptions”

- Ask for unnecessary prescriptions

- Expect to get a prescription for every condition

-  2 (3 df) = 11.11 p < .05

-  2 (3 df) = 5.36 , n s

- N=500

## Problems DTCA Creates for My Patients and Practice... “Creates Anxiety”

- Anxiety about
- potential diseases

- Anxiety about
- potential side effects

-  2 (3 df) = 19.56 p < .01

-  2 (3 df) = 5.67 , n s

- N=500

## Problems DTCA Creates for My Patients and Practice.. “Dr - Patient Tensions”

- Tension between you and patients

- Questioning /Second - Guessing Diagnosis

-  2 (3 df) = 4.43 p > .1

-  2 (3 df) = 8.96 ,p < .05

- N=500

## Attitudes About Potential Positive Effects of DTCA on Patients and Practice

## Benefits DTCA Creates for My Patients and Practice...

- Increase
- Awareness

- Increase
- Involvement

- Increase
- Compliance

- Extend
- “Reach”

- Dr-Pt
- Interaction

**Aware of**
**problems**
**earlier**

**Aware of**
**possible**
**treatmts**

**More**
**involved**
**in health**
**care**

**Avg. **
**patient**
**more **
**concerned**
**about **
**health**

**Likely to**
**use meds**
**properly**

**Adhere **
**to **
**treatmt**
**regimen**

**Hard-to-**
**reach**
**patients**
**come in**

**Seek **
**treatmt**
**for **
**potentially**
**serious**
**condits.**

**Ask**
**better**
**questions**

**Better**
**discussions**
**about**
**health**

- N=500

## Overall Impact of DTCA on Patients and Practice

- Percent

- Overall, how would you say DTC advertising has affected your patients and your practice?
- 							 	       N=500

-  2 (4 df) = 9.74 p < .05