# Presentation: 116786

## The Impact of Direct-to-Consumer Prescription Drug Advertising on the Physician-Patient Relationship

- Kathryn J. Aikin,  Ph.D.
- Division of Drug Marketing, Advertising
- and Communications, FDA
- September 22, 2003

## Patient Survey Results

## 1999 and 2002 Consumer Surveys: Methodology

**1999**
- National probability sample conducted by telephone interview
- 1,081 respondents, 960 who had visited a doctor in the last three months for a problem of their own

**2002**
- National probability sample conducted by telephone interview
- 943 respondents who had visited a doctor in the last three months for a problem of their own

**Notes:**
Just a quick overview of the survey methodology:

## Brief Summary in Print Advertising

## How Much of the Brief Summary Do You Read?

-    1999 N = 688						2002 N = 595

**0.3%**

## How much of brief summary do you read when interested?  

- 2002   N = 272

- 45%

- }

## Advertising and Consumer Behavior

## Searching for More Information

- Has an ad ever caused you to look for more information, for example, about the drug or about your health?**    **
-     1999 N = 499						2002 N =**  **576**                  **

**1999**
**Patients**

**2002**
**Patients**

**YES**

## Sources of Information

- Own Doctor			     83 %		89 %
- Pharmacist			     50 %		51 %
- Reference Book			     38 %		40 %
- Nurse				     33 %		40%
- Friend, Relative, Neighbor	     31 %		38%
- Other Doctor			     24 %		25 %
- 1-800 number			     19 %		15 %
- Internet				     18 %		38 %
- Magazine				     17 %		18 %
- Newspaper	 		       8 %		  7 %

- 	    1999 	       2002

## What information did you look for?

- 							2002   N = 248

## Asking About a New Condition

- Has an ad ever caused you to ask a doctor about a medical condition or illness of your own that you had not talked to a doctor about before?**    **
-      1999 N = 688						2002 N =**  **762**                  **

**YES**

**1999**
**Patients**

**2002**
**Patients**

## Reasons for Visiting Doctor

- *

- *

- *new item 2002

- *

- *

- *

## Influence of Drug Inquiries on Prescribing Behavior

## Did you go to this visit expecting your doctor to prescribe a drug for you?

- 2002   N = 944

- yes

- no

## What was it that made you expect Dr to prescribe a drug?

- 							2002   N = 382

## Rx Requests and Doctor Behavior:2002

## Patient Attitudes About DTC Advertising

**2002**

**1999**

**              ****n = 703                         n = 759                      n = 706                        n = 760**

**2002**

**1999**

- I like seeing advertisements
- for prescription drugs

- Advertisements for prescription
- drugs help make me aware of
- new drugs

- Attitude Response Frequencies, 1999 vs. 2002

**2002**

**1999**

**2002**

**1999**

**Advertisements for prescription drugs**
**give enough information for me to**
**decide whether I should discuss**
**the drug with my doctor**

- Advertisements for prescription drug
- help me have better discussions
- with my doctor

**             ****n = 706                        n = 759                      n = 704                        n = 761**

- Attitude Response Frequencies, 1999 vs. 2002:

**2002**

**1999**

- Advertisements for prescription drugs
- help me make better decisions
- about my health

**        ****n = 706        ****	****                        n = 760**

- Attitude Response Frequencies, 1999 vs. 2002

**2002**

**1999**

**2002**

**1999**

**Advertisements for prescription drugs**
**do not give enough information about**
**the possible risks and negative effects **
**of using the drug**

**Advertisements for prescription drugs**
**do not give enough information about**
**the possible benefits and positive effects **
**of using the drug**

**         ****n = 700                        n = 759                      n = 697                        n = 752**

- Attitude Response Frequencies, 1999 vs. 2002

**2002**

**1999**

**2002**

**1999**

- Advertisements for prescription drugs
- make the drugs seem better than they
- really are

**Advertisements for prescription drugs**
**make it seem like a doctor is not needed**
**to decide whether a drug is right for me**

**          ****n = 695                         n = 753                      n = 705                        n = 758**

- Attitude Response Frequencies, 1999 vs. 2002

**2002**

**1999**

**I would not talk with my doctor about an advertisement for a prescription drug because it would seem like I did not trust my doctor**

**	****              ****n = 702                       ****	****	****              n = 756**

- Attitude Response Frequencies, 1999 vs. 2002

## Physician Survey Results

## 2002 Physician Survey: Methodology

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

## 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%
- Compared to other encounters with patients who have initiated a discussion about a prescription drug they saw advertised, how representative was this patient encounter?
- Very/Somewhat representative		89%

- Physicians N = 500

- Physicians N = 459

## Beneficial Effects

- Physicians 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**_

- Physicians N = 187

**51%    55%**

**38%    45%**

**  ****9%    12%**

** ****12%      9%**

**  ****4%     14**%

**5%      7%**

**  ****3%      0%**

**  ****4%      2%**

**All physicians**

**<**

## Problems

- Physicians 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**_

- Physicians 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?

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

- GPs
- N=229

- Specialists
- N=223

- 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

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

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

- GPs
- N=232

- Specialists
- N=227

- N=137

- N=99

## 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?

- GPs
- N=194

- Specialists
- N=165

## 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?

- GPs
- N=194

- Specialists
- N=165

- N=126

- N=85

## 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%**

**51%    32%**

**33%    11%**

**26%    19%**

**22%     6%**

**24%     0%**

**All physicians**

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

** ****>**

** ****>**

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** ****>**

** ****<**

** ****<**

** ****<**

## 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

** ****>**

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** ****<**

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## 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?					Physicians N = 459

## Perceived Pressure to Prescribe

- Percent

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

## Attitudes About Impact of DTCA on Patient Understanding

## What patients understand about advertised drugs...

**Possible **
**benefits &**
**positive**
**effects**

**How to **
**get more**
**info about**
**drug or**
**condition**

**What **
**condition**
**drug **
**treats**

**Who **
**could**
**use drug**

**Drug **
**avail**
**only by**
**Rx**

**Only Dr**
**can decide**
**if drug is**
**right**

- Physicians N=500

## What patients understand about advertised drugs...

**Possible**
**risks &**
**negative**
**effects**

**Who **
**should**
**not use**
**drug**

- Physicians N=500

**Limitations**
**of drug**
**efficacy**

## Beliefs 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**

- Physicians N=500

**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**

## Beliefs 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

- Physicians 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

- Physicians 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

- Physicians N=500

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

- Anxiety about
- potential diseases

- Anxiety about
- potential side effects

- Physicians N=500

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

- Tension between you and patients

- Questioning /Second - Guessing Diagnosis

- Physicians 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?
- 							Physicians N=500

## Overall Summary

## Summary

- DTC ads increase awareness of possible treatments
- DTC ads do not convey information about risks and benefits equally well
- Physicians believe patients understand benefits much better than risks
- Physicians believe DTC ads confuse patients about relative risks and benefits of prescription drugs

## Summary, con’t.

- Patients do not typically read the brief summary in DTC print ads unless they are interested in the product
- Consumer-friendly brief summary not yet the norm
- Patients still use their doctors as #1 information source when looking for more information about a drug or treatment
- Pharmacists, nurses also highly ranked as sources

## Summary, con’t.

- Brand-specific requests are likely to be accommodated
- Patients who ask about a brand are more likely to be prescribed that brand than patients who ask in general
- Vast majority of patients who ask about a brand have the condition that drug treats
- General Practitioners are more likely to prescribe a requested brand than Specialists
- General Practitioners report feeling more pressured to prescribe

## Summary, con’t.

- Patient attitudes about many aspects of DTC ads have become less positive over time
- General Practitioners report more negative beliefs about potential negative effects of DTC ads than Specialists
- Physicians are evenly divided in opinions about overall impact of DTC ads on patients and practice- 1/3 positive, 1/3 no effect, 1/3 negative
- General Practitioners report a more negative overall impact of DTC ads than Specialists