患者对直接销售广告中的抗抑郁药的要求的影响:一项随机对照试验
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
概括
患者的要求显著影响医生为抑郁症开处方. 品牌特定的请求增加了抗抑郁药的处方,而一般的请求改善了主要抑郁症的整体护理质量.
科学领域:
- 医学研究 医学研究
- 临床心理学 临床心理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 处方药的直接向消费者 (DTC) 广告在美国很普遍,并引起了争论.
- 担忧包括过度处方与避免对污名化疾病的治疗方法的不充分使用.
研究的目的:
- 评估与DTC广告相关的患者请求如何影响医生对患有抑郁症状的患者的初始治疗决策.
主要方法:
- 一项随机试验使用了具有严重抑郁或适应障碍的标准化患者 (SPs).
- 在不预告的初级保健医生访问期间,医生在不预告的访问中提出了品牌特定,一般或没有药物的请求.
- 使用统计模型收集和分析了处方,转诊和随访数据.
主要成果:
- 对抗抑郁药的处方率更高,与特定品牌 (53%) 和一般性 (76%) 要求相比,对重大抑郁症没有要求 (31%).
- 对于适应障碍,处方率为55% (特定品牌),39% (一般),10% (没有).
- 大型抑郁症的一般请求在98%的案例中导致了最低可接受的护理,而品牌特定的90%和没有请求的56%.
结论:
- 患者的要求显然影响医生对抑郁症和适应障碍的处方模式.
- DTC广告可能对医疗保健质量产生双重影响,可能导致治疗的过度使用和不足使用.
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