Effects of patient medication requests on physician prescribing behavior: results of a factorial experiment.
Effects of patient medication requests on physician prescribing behavior: results of a factorial experiment.
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DOI：
10.1097/mlr.0000000000000096
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发表时间：
2014-04
期刊：
影响因子：
3
通讯作者：
Fischer MA
中科院分区：
文献类型：
--
作者：
McKinlay JB;Trachtenberg F;Marceau LD;Katz JN;Fischer MA
由于互联网搜索，朋友的建议和药品广告，特别是直接面向消费者的广告，患者越来越多地在医生遇到时要求药物。在不受患者、医生和实践设置因素混淆的情况下，评估患者药物要求对医生处方行为的影响。在192名初级保健医生中进行了两个实验，每个实验使用不同的基于视频的场景;一个未确诊的“患者”的症状强烈提示坐骨神经痛，一个“患者”已经诊断为慢性膝关节骨关节炎。一半有坐骨神经痛症状的患者要求服用羟考酮，而另一半则要求服用有助于缓解疼痛的药物。同样，一半的膝关节骨关节炎患者特别要求西乐葆，一半要求帮助缓解疼痛。为了增加可推广性并确保有足够的数量，我们从美国6个州招募了192名初级保健医生。主要结果是医生是否会同意患者的药物要求。处方的替代止痛药是次要结局。19.8%的坐骨神经痛患者要求羟考酮将收到处方羟考酮，相比之下，1%的人没有具体的要求（p=0.001）。53%的膝关节骨关节炎患者要求西乐葆将接受它，相比之下，24%的患者没有要求（p=0.001）。需要羟考酮的患者更可能接受强麻醉剂（p=0.001），而不太可能接受弱麻醉剂（p=0.01）。要求西乐葆的患者接受非选择性NSAID的可能性要小得多（p=0.008）。没有病人的属性，医生或组织因素影响医生的意愿，同意病人的用药要求。在这两种情况下，激活的患者药物请求大大影响了医生的处方决策，尽管所请求的药物的缺点。
Due to internet searches, advice from friends and pharmaceutical advertising, especially direct-to-consumer advertising, patients are increasingly activated to request medications during a physician encounter. To estimate the effect of patient requests for medications on physician prescribing behavior, unconfounded by patient ,physician and practice setting factors. Two experiments were conducted among 192 primary care physicians, each using different video-based scenarios; an undiagnosed “patient” with symptoms strongly suggesting sciatica, and a “patient” with already diagnosed chronic knee osteoarthritis. Half of patients with sciatica symptoms requested oxycodone, while the other half requested something to help with pain. Similarly, half of knee osteoarthritis patients specifically requested Celebrex and half requested something to help with pain. To increase generalizability and ensure sufficient numbers were available, we recuited 192 Primary Care Physicians from 6 US states. The primary outcome was whether physicians would accede to a patient’s request for a medication. Alternative pain medications prescribed were secondary outcomes. 19.8% of sciatica patients requesting oxycodone would receive a prescription for oxycodone, compared with 1% of those making no specific request (p=0.001). 53% of knee osteoarthritis patients requesting Celebrex would receive it, compared with 24% of patients making no request (p=0.001). Patients requesting oxycodone were more likely to receive a strong narcotic (p=0.001) and less likely to receive a weak narcotic (p=0.01). Patients requesting Celebrex were much less likely to receive a non-selective NSAID (p=0.008). No patient attributes, physician or organizational factors influenced a physician’s willingness to accede to a patient’s medication request. In both scenarios, activated patient requests for a medication substantially affected physician prescribing decisions, despite the drawbacks of the requested medications.