March 26, 2014
Physicians Often Grant Patient Medication Requests, Even If Contrary to Usual Prescribing

Watertown, MA—Patients asking for specific medications often are obliged by physicians, even though another drug would be more likely to be prescribed in the absence of a request.

That’s according to a study published recently in the journal Medical Care, which sought to determine how much influence a specific request had on prescribing behavior. Background in the article noted that medication requests are on the upswing because of Internet searches, advice from friends, and pharmaceutical advertising, especially direct-to-consumer (DTC) advertising.

“A patient request for a specific medication dramatically increases the rate at which physicians prescribe that medication,” according to the research from the New England Research Institutes. “These results highlight potential negative impacts of DTC advertising and other forms of activation in medication requests.”

To evaluate the effects of “activated” patient requests for specific medications, researchers created videos in which professional actors portrayed patients with two common, painful conditions: sciatica causing back and leg pain or osteoarthritis causing knee pain.

In the video, half of the actors portraying patients with sciatica specifically requested oxycodone, while half of the actors portraying patients with knee arthritis requested the prescription drug Celebrex. The other half of “patients” requested “just something to make it better.” In the videos, patients requesting oxycodone said they had tried their spouse's leftover medication, while those requesting Celebrex said they saw it advertised, and that a coworker took it and said it really helped.

The video scenarios were randomly shown to 192 primary care physicians, who were then asked a series of questions about diagnosis and management, including what treatment they would recommend. The report notes that “activated” patient requests for drugs had a strong effect on recommended treatments.

“In both scenarios, activated patient requests for a medication substantially affected physician-prescribing decisions, despite the drawbacks of the requested medications,” the researchers report.

About 20% of sciatica patients requesting oxycodone would receive it, compared to 1% of those making no specific request, and about half of knee arthritis patients requesting Celebrex would receive that drug, compared to one-fourth of those requesting no specific medication, according to the study results.

Gender, race/ethnicity or socioeconomic status of the patient had no effect on the inclination to grant a patients’ request, the article notes.

Even if they didn’t receive the specific drug they requested, treatment patterns differed for patients who made active requests, the authors point out. “Patients requesting oxycodone were more likely to receive a strong narcotic and less likely to receive a weak narcotic,” they write. “Patients requesting Celebrex were much less likely to receive a non-selective NSAID.”

In commenting on the study, G. Caleb Alexander, MD, MS, Deputy Editor of Medical Care, points to the continued debate on DTC advertising. “Supporters defend the practice as a way to empower consumers, while opponents argue that commercially motivated messages leads to inappropriate patient requests for medication,” Alexander says. “In order to resolve this debate, more research is needed to determine the effects of DTC advertising on patient and physician behavior, especially how it affects prescribing decisions and health outcomes.”

“The results highlight the ongoing need for improving strategies for patient-physician communication,” according to the study authors.

U.S. Pharmacist Social Connect