# Presentation: 496239

## Consumer and Physician Reports on the Health Effects of DTCA 

**Joel S. Weissman, Ph.D., David Blumenthal, MD, Alvin J. Silk, Ph.D., Robert Leitman, MA, Kinga Zapert, Ph.D., Michael Newman, MPP, Sandra Feibelmann, MPH**** **
**MGH Institute for Health Policy & Harris Interactive, Inc.**

**FDA-CDER Public Meeting**
**September 22-23, 2003**
- Washington, DC

## The Harvard/Harris National DTCA Surveys

- Two surveys – General Public and Physicians
- Purpose - to address healthcare use and effects, including perceived outcomes
- Both surveys focused on the “DTCA visit” =  Most recent physician visit during which patients discussed a drug they saw advertised.
- Both studies jointly funded by the AMA-Industry Roundtable Steering Committee and selected members of the Ad Hoc Working Group on the Economics of the Pharmaceutical Industry

## Methods

- Telephone survey of general public
- Consumers / Patients (N=3000)
- response rate = 53%
- Results published in Health Affairs, 2/26/03
- Mailed survey of physicians
- Specialties that see office patients
- N= 643 physicians
- Response rate = 53%
- Paper under review

## Consumer Survey: Study Questions

**What sorts of conditions are associated with DTCA visits?**
**What actions are taken during DTCA visits?  **
**What outcomes are reported as a result of taking DTCA medications? **

## DTCA visits resulted in a number of new diagnoses, many of which are important

**No diagnosis**

**46%**

**25%**

**20%**

**New diagnosis**

**Conversation was about existing condition**

**Missing/Unknown = 9%**

**43% of new diagnoses were “high priority” conditions according to AHRQ/IOM criteria**

## DTCA visits often led to prescribing the advertised drug, as well as the use of a range of other health services

- High Influence#
**46.9%**
**71.4**
**24.6***
**45.2***
**19.9**
**50.4***

**Prescribed DTCA drug...............**
**Prescribed any drug..................**
**Referred to specialist.................**
**Suggested lifestyle change.........**
**Recommended OTC drug............**
**Recommended diagnostic test.....**
** ****test**

-  Low Influence
**40.6%**
**73.8**
**38.6**
**57.3**
**18.4**
**62.3**

**Weissman, et al, Health Affairs, 2003**

***** - p<.05; # - DTCA was one of top two reasons for the visit

**--Patient Reports**

## Few patients reported adverse health outcomes from taking DTCA and other drugs prescribed as a result of the visit

_**Type of Drug**_

**Weissman, et al, AHSR 2002**

**Among Patients Receiving & Taking Prescription Drugs**

- * Totals do not include Missing / Not Sure

## Physician Survey:Study Questions

- What do physicians perceive to be the effects of DTCA on their patients and their practices?

## U.S. Physicians Perceived Some Negative Aspects of DTCA

## U.S. Physicians Perceived Some Positive Aspects of DTCA

## Study Questions for Physician Survey

- What do physicians perceive to be the effects of DTCA on their patient practices?
- What proportion of physician visits involve DTCA discussions?  For what conditions?

## Only a small percentage of physician visits involved a DTCA discussion

**3.1% of physician visits involved a DTCA discussion**

## Most Commonly Discussed Conditions

- Reported by Patients

- 1.	Allergies
- 2.	Arthritis
- 3.	High Cholesterol
- 4.	Diabetes
- 5.	Reflux Disease, etc.
- 6.	Hypertension
- 7.	Depression
- 8-10. Heart/Asthma/Diet

## Study Questions for Physician Survey

- What do physicians perceive to be the effects of DTCA on their patient practices?
- What proportion of physician visits involve DTCA discussions?  For what conditions?
- How often do physicians prescribe DTCA drugs to accommodate patients’ wishes?

## Accommodation of Patient Requests

**Among Cases Where DTCA Drug was Prescribed (39% of recent visits):**

**All**             (n=250)

## Study Limitations

- No good control group with which to compare some of our findings (Not a RCT)
- Possible recall bias
- Medical records would have provided more clinical detail
- 53% response rate may miss information from important groups of patients or physicians
- Predicted vs. actual outcomes

## Conclusions I: Reported Health Effects

- DTCA discussions are associated with new diagnoses, many for high priority conditions
- DTCA discussions may trigger health care consumption in addition to DTCA drugs, although certain actions were less likely for patients heavily influenced by DTCA
- Outcomes of treatment generally reported to be positive, although some physicians  perceive little or no effect on patients’ overall health
- Did _not_ find evidence of burden due to discussion of minor/lifestyle conditions, or widespread negative outcomes from inappropriate prescribing

## Conclusions – II: Prescribing Behavior 

- Accommodating patients by prescribing advertised drugs when other equally effective drugs are available is a relatively common practice
- If heavily advertised drugs are found in future research to be more expensive, such behavior could have cost implications
- However, cost considerations may also result in prescribing less expensive alternatives to advertised drugs
- Accommodating patients by prescribing advertised drugs when _more_ effective treatments or drugs are available is rare, although potentially cause for concern

## End of Presentation