Distinguishing characteristics of patients who seek more information or request a prescription in response to direct-to-consumer advertisements

Direct-to-consumer advertising effects on nurse-patient relationship, authority, and prescribing appropriateness

BACKGROUND:

Discussing direct-to-consumer advertising of prescription drugs during a visit could affect prescribing practices and provider-patient relationship.

RESEARCH OBJECTIVES:

The study examines advanced practice nurse prescribers' perceptions of direct-to-consumer advertising and its effects on nurse-patient relationship, prescriptive authority, and appropriateness of patient clinical requests.

RESEARCH DESIGN:

A cross-sectional survey design was implemented.

PARTICIPANTS AND RESEARCH CONTEXT:

The random sample consisted of 316 nurses (27.17% response rate) in one of the Midwestern states in the United States. Pearson's chi-square analysis and multiple/multinomial logistic regression analyses were used.

ETHICAL CONSIDERATIONS:

Permission to conduct the study was obtained from the university's Institutional Review Board. Participation was voluntary, and measures were taken to protect the anonymity and confidentiality of consenting participants.

FINDINGS:

Most nurses (69%) believed that patients were "poor or very poor" at assessing the relevance of drug advertisements, 61% reported that the increase in drugs advertisements directed at patient was "a bad or a very bad thing," and only 16% thought the advertisements were accurate to "a very or to a great extent." Improved nurse-patient relationship was associated with factors such as the patient not bringing printed material, seeking nurse's opinion only, taking responsibility for their health, and not challenging nurse's prescriptive authority.

DISCUSSION:

Advertising discussion during a visit could improve as well as pose a challenge to a nurse-patient relationship and nurse's prescriptive authority.

CONCLUSION:

The positives of discussing advertising information can be maximized and the negatives minimized through enhanced interpersonal nurse-patient communication.

Then and Now: Examining How Consumer Communication and Attitudes of Direct-to-Consumer Pharmaceutical Advertising Have Changed in the Last Decade

This study examines changes over a 10-year period in consumer reports of communication with health care providers about direct-to-consumer advertised (DTCA) medications. Two rounds of survey data were collected in 2003 and 2012 using repeated cross-sectional procedures to examine consumer willingness to discuss DTCA medications, content and tone of those conversations, and attitudes about the advertisements. In total, 472 surveys were analyzed. Generally, we found physician-patient conversations, attitudes, and behaviors regarding DTCA have changed. Consumers in 2012 reported talking significantly less about the names of the advertised drug, comparing the advertised drug with their current medication, and sharing general information than consumers in 2003. Attitudes toward the advertisements were significantly more negative in 2012 compared to 2003. Of those who specifically asked for a prescription, the proportion of patients who received the prescription was significantly lower in 2012, despite research suggesting increased rates of prescriptions. These results are interpreted in light of previous research about the lack of research examining the actual communication between physicians and patients on this topic. Limitations of the study are provided along with directions for future research about DTCA and physician-patient communication.

Variables associated with seeking information from doctors and the internet after exposure to direct-to-consumer advertisements for prescription medications

This study examines variables associated with seeking information from doctors, the Internet, and a combination of both doctors and Internet after exposure to direct-to-consumer advertisements. Data were analyzed from 462 college students. Younger age, women, and health insurance were associated with greater odds for doctor; women, subjective norms, intentions, and greater time since seen doctor were associated with greater odds for Internet; and African American, Hispanic, subjective norms, intentions, and health insurance were associated with greater odds for both doctor and Internet. Marketers of direct-to-consumer advertisements can use these findings for tailoring and targeting direct-to-consumer advertisements.

An exploratory study of adolescent female reactions to direct-to-consumer advertising: the case of the Human Papillomavirus (HPV) Vaccine

When the human papillomavirus (HPV) vaccine was approved in 2006, an extensive direct-to-consumer (DTC) advertising campaign raised awareness and promoted vaccination. This study explores adolescents' exposure to and understanding of the messages in these advertisements. Sixty-seven African American females participated in a focus group about DTC advertising for the HPV vaccine. Virtually all adolescents had seen an HPV vaccine DTC advertisement, but most did not understand the health information contained in it. If DTC advertising is to be an effective source of health information for adolescents in the future, it must take into account the unique features of an adolescent audience.

Self-reported responsiveness to direct-to-consumer drug advertising and medication use: results of a national survey

Background

Direct-to-consumer (DTC) marketing of pharmaceuticals is controversial, yet effective. Little is known relating patterns of medication use to patient responsiveness to DTC.

Methods

We conducted a secondary analysis of data collected in national telephone survey on knowledge of and attitudes toward DTC advertisements. The survey of 1081 U.S. adults (response rate = 65%) was conducted by the Food and Drug Administration (FDA). Responsiveness to DTC was defined as an affirmative response to the item: "Has an advertisement for a prescription drug 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?" Patients reported number of prescription and over-the-counter (OTC) medicines taken as well as demographic and personal health information.

Results

Of 771 respondents who met study criteria, 195 (25%) were responsive to DTC. Only 7% respondents taking no prescription were responsive, whereas 45% of respondents taking 5 or more prescription medications were responsive. This trend remained significant (p trend .0009) even when controlling for age, gender, race, educational attainment, income, self-reported health status, and whether respondents "liked" DTC advertising. There was no relationship between the number of OTC medications taken and the propensity to discuss health-related problems in response to DTC advertisements (p = .4).

Conclusion

There is a strong cross-sectional relationship between the number of prescription, but not OTC, drugs used and responsiveness to DTC advertising. Although this relationship could be explained by physician compliance with patient requests for medications, it is also plausible that DTC advertisements have a particular appeal to patients prone to taking multiple medications. Outpatients motivated to discuss medical conditions based on their exposure to DTC advertising may require a careful medication history to evaluate for therapeutic duplication or overmedication.

Cancer-related direct-to-consumer advertising: awareness, perceptions, and reported impact among patients undergoing active cancer treatment

PURPOSE

Although cancer-related direct-to-consumer advertising (CR-DTCA) is prevalent, little is known about cancer patients' experiences with this controversial medium of medical communication.

METHODS

We administered a 41-item, mailed questionnaire to consecutive patients with breast and hematologic malignancies who were undergoing active treatment at our institution. We assessed awareness of CR-DTCA within the prior year, perceptions of CR-DTCA, and CR-DTCA-prompted patient and provider behaviors.

RESULTS

We received 348 completed questionnaires (response rate, 75.0%). Overall, 86.2% reported being aware of CR-DTCA, most frequently from television (77.7%). Awareness did not vary with clinical or sociodemographic factors except that patients were more likely to be aware of CR-DTCA for products specific to their cancer types (P < .0001). A majority of those aware reported that CR-DTCA made them "aware of treatments they did not know about" (62.2%), provided information in "a balanced manner" (65.2%), and helped them to have "better discussions" with their provider (56.8%). These perceptions were significantly more favorable among those who had not graduated from college (P < .05 for each). Overall, 11.2% reported that CR-DTCA made them "less confident" in their providers' judgment. Of those aware, 17.3% reported talking to their provider about an advertised medication, although less than one fifth of those reported receiving a prescription for the advertised medication.

CONCLUSION

The patients in our cohort were highly aware of CR-DTCA. CR-DTCA was found to be accessible and useful; however, it decreased some patients' confidence in their providers' judgment. CR-DTCA prompted a modest amount of patient-provider discussion but infrequent patient-reported changes in therapy.