Influence of patients' requests for direct-to-consumer advertised antidepressants - A randomized controlled trial
Influence of patients' requests for direct-to-consumer advertised antidepressants - A randomized controlled trial
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DOI：
10.1001/jama.293.16.1995
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发表时间：
2005-04-27
影响因子：
120.7
通讯作者：
Franks, P
中科院分区：
文献类型：
--
作者：
Kravitz, RL;Epstein, RM;Franks, P
背景 在美国，处方药的直接面向消费者 (DTC) 广告无处不在，但也存在争议。批评者指责它会导致过度处方，而支持者则反驳说，它有助于避免有效治疗的使用不足，特别是对于那些认识不足或被污名化的疾病。目的 确定患者的 DTC 相关请求对医生对抑郁症状患者的初始治疗决策的影响。设计使用标准化患者 (SP) 的随机试验。通过将 2 种情况（重度抑郁症或情绪低落的适应障碍）与 3 种请求类型（品牌特定、一般或无）结合起来，创建了 6 个 SP 角色。加利福尼亚州旧金山； 2003 年 5 月至 2004 年 5 月间在纽约州罗彻斯特进行。 参与者 从个体和团体诊所以及健康维护组织招募的 152 名家庭医生和普通内科医生；合作率从 53% 到 61% 不等。 干预 SP 被随机分配进行 298 次暗访，由于分配受到限制，因此医生看到 1 名 SP 患有重度抑郁症，1 名 SP 患有适应障碍。 SP。约三分之一的就诊提出了特定品牌药物请求、一般药物请求或没有请求（控制条件）。 主要结果指标 从 SP 书面报告、就诊录音、图表审查以及书面处方和药物样本分析中获得有关处方、心理健康转诊和初级保健随访的数据。使用列联表评估请求类型对处方的影响，并在广义线性混合模型中进行确认，该模型考虑了聚类并根据地点、医生和就诊特征进行了调整。结果标准化患者角色保真度非常好，医生看过 SP 的怀疑率为 13%。在重度抑郁症中，提出特定品牌、一般和无要求的 SP 的抗抑郁药处方率分别为 53%、76% 和 31%（P
Context Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized.Objective To ascertain the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms.Design Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none).Setting Off ices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004.Participants One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%.Interventions The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs. made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits.Main Outcome Measures Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics.Results Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P