# Presentation: 302872

## “I Saw This Ad Last Night ...”

- Direct-To-Consumer Advertising and Incidence of Patient Requests for Medications
- September 23, 2003

## Principal Investigators

- Karyn Baum, MD
- Jon Hallberg, MD
- David Power, MD, MPH
- University of Minnesota—Twin Cities
- Department of Internal Medicine
- Department of Family Practice and Community Health

## Background

- Physicians report an increasing amount of time spent in discussing direct-to-consumer (DTC) advertised drugs with patients
- Most of these reports are anecdotal
- Little information exists on the impact that DTC advertising has on daily primary care practice

## Background (continued)

- Advantages of DTC
- Increases awareness of treatment options and underlying disease
- Empowerment
- Discovering of  co-morbidities
- Lowering of overall health costs

- Disadvantages
- Pressure to prescribe expensive and potentially unnecessary drugs
- Wasted time
- Adversarial relationship between provider and patient
- Elevation of drug and overall health costs

## Questions

- How often do patients want to discuss DTC advertised  medications?
- How strongly do they desire particular medications?
- Where/how did they learn of the medications?
- Are there certain predictive demographic characteristics that indicate who is more likely to inquire about DTC advertised medications?

## Methods

- All patients checking in for appointments at three University of Minnesota-affiliated primary care clinics during a two-week period were given written, anonymous, surveys while waiting in clinic lobbies
- Completion of survey was voluntary

## Methods (continued)

- Bethesda/St. Joseph’s, St. Paul, MN
- 	-	Inner City
- 	-	Large Hmong population
- Methodist, St. Louis Park, MN
- -		Inner-ring suburb of Minneapolis
- -		Strong middle class background
- Primary Care Center, Minneapolis, MN
- -		On the University of Minnesota campus
- -		Diverse patient base; highly educated

## Survey Questions

- Do you plan to discuss a specific medication with your doctor?
- Did you make your appointment for this purpose?
- Where did you learn of the medication?
- How important is it that you receive this medication?
- Demographic information

## Results

- 962 patients completed the survey
- 60% response rate
- Reasons for non-completion:
- Waiting for interpreter
- Rooming process was *too *efficient in some cases

## Results (continued)

- 99 (10.3%) of those planned to discuss with their physician a medication they had learned of outside the physician’s office
- 30 patients (3.1%) specifically made their appointment for this purpose

## Results (continued)

- Of those wanting to discuss a medication, 84 (84.8%) could name it or knew enough to describe it

## Results (continued)

- Patients learned of these medications mainly from:
- -	Television 			37.2%
- -	Family and friends 	27.2%
- -	Magazines 			15.7%

## Results (continued)

- These patients were split as to how strongly they felt they needed these medications
- 21 (22.8%) 	were  “very sure” they needed the 			medication
- 32 (34.8%) 	were undecided
- 13 (14.1%)  	were very “unsure” they needed it

## Results (continued)

- 53 different medications were identified by name; the most common were:
- Prevacid 		4
- Viagra 		3
- Vioxx 		3
- Allegra 		2
- Celexa 		2
- Zoloft 		2

## Results (continued)

- More women than men completed the surveys
- 63.1% v. 36.9%
- The majority had completed *more* than 12 years of schooling
- 59.8%

## Results (continued)

- English was the most commonly spoken primary language 				76.2%
- “Other” 				 9.1%
- Hmong 				 8.6%
- Spanish 				 2.2%
- Vietnamese 			 1.6%
- Somali 				 1.4%
- Russian 			 	 1.0%
- 36 different languages were identified as “primary”

## Results (continued)Other Languages

- Afrikaan
- Akan
- Amharic
- Arabic
- Greek
- Hungarian
- Igbo
- Karen

## Results (continued)Other Languages

- Khmer
- Luo
- Oromo
- Punjabi
- Sioux
- Slovak
- Swedish
- Tibetan
- Tigrena

## Results (continued)

*No* significant differences based on:
- Clinic site
- Age
- Gender
- Educational level
- Ethnicity
- Primary language

## Conclusions

- Patients commonly want to discuss a wide range of DTC advertised medications with their primary care physicians
- Occasionally, patients make appointments specifically for that purpose

## Conclusions (continued)

- Patients learn of these medications from a variety of sources; television most common source
- 	Patients are uncertain as to their need for them, but want to discuss them nevertheless
- A significant minority will request a particular drug

## Conclusions (continued)

- There were no significant predictable demographic characteristics that would identify who might be more interested in discussing or requesting a DTC advertised medication

## Further Studies

- Larger
- Multi-institutional
- Follow-up; How often do patients get the medications they requested/wanted to discuss
- Are patients becoming (too) alarmed by the side-effect warnings (on TV) for drugs they’re already on?

## Contact Information

**Jon Hallberg, MD**
**Assistant Professor**
**Department of Family Practice**
**and Community Health**
**University of Minnesota**
**hallb006@umn.edu**