消費者に直接販売される抗うつ薬に対する患者の要求の影響:ランダム化制御試験
Richard L Kravitz1, Ronald M Epstein, Mitchell D Feldman
1Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, CA 95817, USA. rlkravitz@ucdavis.edu
JAMA
|April 28, 2005
まとめ
患者の要求は,うつ病に対する医師の処方箋に大きく影響します. ブランド特有のリクエストは抗うつ剤の処方量を増加させ,一般的なリクエストは重度うつ病の全般的なケア品質を向上させた.
科学分野:
- 医学研究 医学研究
- 臨床心理学の臨床心理学について
- 医療サービス 研究 医療サービス
背景:
- 処方薬の直接消費者向け (DTC) 広告は,米国で広く普及し,議論されています.
- 懸念事項には,汚名付けられた状態に対する治療法の過度な処方と過度の使用を回避することが含まれます.
研究 の 目的:
- DTCの広告に関連する患者の要求が,うつ病症状の患者に対する医師の初期治療決定にどのように影響するか評価する.
主な方法:
- ランダム化試験では,重度のうつ病または適応障害を呈する標準化された患者 (SPs) が使用されました.
- SPは,プライマリケア医への予期せぬ訪問中に,ブランド特異的,一般的,または薬物のない要求を行いました.
- 処方,紹介,およびフォローアップのデータは,統計モデルを使用して収集および分析されました.
主要な成果:
- 抗うつ剤の処方率は,メジャーうつ病の31% (31%) と比較して,ブランド特異的な (53%) と一般的な (76%) 要求で高かった.
- 適応障害の処方率は55% (ブランド別),39% (一般),10% (存在しない) であった.
- 重度のうつ病に対する一般的な要求は, 98% のケースで最低限の受け入れ可能なケアにつながり,ブランド特有の 90% と,要求なしの 56% と比較されます.
結論:
- 患者の要求は,うつ病や適応障害の処方パターンに医者の影響が実証されている.
- DTCの広告は,医療の質に二重の影響を及ぼし,治療の過剰利用と過小利用の両方を引き起こす可能性があります.
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