When making decisions about a patient, do physicians follow clinical guidelines and clinical evidence, or does advertising and news coverage directly or indirectly influence a physician’s decisions?
In order to answer these questions and assess factors influencing physician treatment choices, the American College of Cardiology (ACC) surveyed 150 ACC members and 253 primary care physicians (PCPs). Results showed that while clinical guidelines and scientific evidence drive treatment decisions, media coverage and advertising when presented by patients also influence clinicians’ prescribing behavior.
The survey also found that nearly all PCPs and cardiologists have responded to a patient inquiry regarding pharmacologic treatments covered in the media. The survey results suggest that PCPs are slightly more likely to field media-related questions, but cardiologists are certainly not immune.
According to clinicians, one out of five patients inquire about treatments that received negative news coverage. Approximately the same number of patients raise questions about pharmaceutical company advertisements. To a lesser extent, patients ask about treatments that received positive news coverage or inquire about advertisements related to lawsuits or personal injury claims concerning patient treatments.
Patient preference stemming from media coverage can have an impact in prescribing behavior. PCPs are more likely than cardiologists to consider patient preferences in response to news coverage or advertising. More than 50 percent of PCPs indicate they had changed a patient prescription or treatment based on such information. News coverage, both negative and positive, was the primary driver of prescription or treatment changes among cardiologists (49 percent and 39 percent, respectively).
In a hypothetical atrial fibrillation patient case scenario concerning the use of novel oral anticoagulants, both PCPs (57 percent) and cardiologists (63 percent) say they would be more likely to consider a patient’s request if he or she had a CHADS2 score of 1. Likelihood to honor the patient request falls with the increase in disease complexity. In patients presenting with a CHADS2 score of 2 or more, notably fewer cardiologists (31 percent) and PCPs (39 percent) would consider the request.
Some clinicians are likely to change prescribing behavior if the media coverage evokes concern. Approximately 40 percent of PCPs and roughly 20 percent of cardiologists say they would consider patient preference due to their own treatment concerns based on news coverage. Also of note, 22 percent of cardiologists say they do not consider patient preference based on media concerns at all, compared to only 8 percent of PCPs.
Media coverage and advertising also have an impact on physician/patient communications. Negative news coverage is most likely to lead to increased communication and place more pressure on the justification of the prescribed regimen. According to PCPs, negative news coverage is the primary communication facilitator leading most often to conversations with patients (72 percent), followed by pharmaceutical ads (62 percent), positive news coverage (60 percent) and legal claim ads (49 percent). Cardiologists indicate fewer discussions around pharmaceutical ads (41 percent) and lawsuits or personal injury claims (37 percent), while negative and positive news coverage are the biggest drivers of discussions at 71 percent and 55 percent, respectively.
The survey highlights the challenge cardiologists and PCPs face in remaining abreast of media coverage as well as having accurate information to present to patients on treatment options. The ACC, working with other specialty societies and consumer groups, has an opportunity to help clinicians anticipate conversations with patients and plan for them by closely monitoring news and advertisements and developing patient-friendly education materials. One example of this is the Anticoagulation Initiative, which focuses on clinical trials and research, advertising, symptomatic presentation and treatment risks and benefits of new oral anticoagulants.
Paul Theriot is director of market intelligence for the American College of Cardiology.