A new literature review of studies of direct-to-consumer (DTC) prescription drug advertising identifies potential positives and negatives for DTC advertising on the patient-prescriber relationship and highlights gaps in the current medical literature on the topic.
The review, authored by researchers at RTI International and the US Food and Drug Administration (FDA), looked at 38 studies published between 1982 and 2017 that examined outcomes reported by patients, prescribers or both regarding their experience with DTC advertising in the US and New Zealand.
Proponents of DTC advertising argue that advertisements can raise awareness about treatments and health conditions, though others argue that DTC advertising can lead to overprescribing.
While previous metanalyses have looked at the potential impacts of DTC advertising on clinical outcomes, this study looks specifically at how DTC advertising affects patient behavior and patient-prescriber relationships.
“This research offers an important perspective on the broader goal of incorporating patient and prescriber voices in decision-making,” the authors write, noting that they identified outcomes on patient information seeking, medication adherence, requests for advertised drugs, prescribing behaviors and perceptions of interactions between patients and prescribers.
The authors found that 22 of the studies reported information seeking behavior following exposure to DTC advertising. Some of these studies associated information seeking more strongly with patients with chronic conditions and those with a more positive view of DTC advertising.
But the authors also found that DCT advertising was rarely the only reason patients scheduled medical visits. One of the studies, published by FDA in 2004
, reported that only 4% of patients saw their doctors exclusively related to getting more information about a drug they had seen an ad for. Two smaller studies that sampled 250 and 500 patients found that 11% of respondents had scheduled appointments or sought medical care due to DTC advertising.
Another large national survey found that 35% of respondents discussed drugs they had seen in DTC advertisements with their physicians, but during already-scheduled visits.
When it comes to patients requesting prescription drugs or changes to their prescriptions, the authors found varying results across the studies they looked at. While the previously mentioned 2004 FDA study found that less than one-third of patients sought a drug to treat their condition after seeing or hearing a DTC advertisement, another larger study found that more than half of respondents requested one or more medical interventions as a result of DTC advertising.
However, the authors note that current research does not address whether prescriptions prompted by DTC advertising were appropriate for those patients or led to overprescribing.
Two of the studies the authors looked at measured how DTC advertising impacts patient adherence. In one, the study found that a quarter of respondents from an online depression support group reported that DTC advertising reminded them to take their medications but did not assess whether DTC advertising caused respondents to alter or discontinue their prescriptions. The other study, which sampled patients at a mental health clinic, found that patients exposed to DTC advertising were more likely to be nonadherent, with more than half of the nonadherent patients citing potential side effects as the reason they changed or discontinued their medication.
While these studies raise questions about the impact of DTC advertising on medication adherence, the authors say it is unclear whether the findings can be generalized to other health conditions.
The authors also found mixed findings on how DTC advertising impacted patient-prescriber relationships. While only five percent of respondents to the 2004 FDA study reported a negative change in their relationship with their prescriber after discussing a DTC advertisement, 23% said such discussions improved their relationship and 72% said the discussion did not change the relationship at all.
Studies that looked at prescribers’ views of how DTC advertising affects the patient-prescriber relationship were also mixed. While some studies found physicians felt DTC advertising led to better discussions with patients, others reported more neutral or negative perceptions.
The authors say their review has highlighted gaps in the literature for DTC advertising, as many of the studies they looked at were more than a decade old and do not reflect current trends in DTC advertising, such as web and social media-based advertising.