Direct-To-Consumer Advertising: Impact on Patient Expectations Regarding Disease Management
Spending on direct-to-consumer advertising (DTCA) in the US rapidly increased from $US150 million in 1992 to $US1.2 billion in 1998 (to the end of November). Despite this level of expenditure, there is no literature on how DTCA affects patients' level of knowledge about medications, physician prescribing behaviour or health outcomes. It seems certain that DTCA will affect patients' expectations of care in disease management, but without answers to the questions outlined above, the direction of that effect is unclear. This article approaches the topic by analysing existing quantitative literature. Two reviews have documented that many DTC advertisements do not give an accurate picture of the products they are promoting. Although there are arguments in favour of leaving out risk information, they are far from proven. Surveys have looked at how DTCA affects consumer attitudes towards medication and care-seeking behaviour. Consumers feel that DTCA will enhance the doctor-patient relationship but physicians believe the opposite. Many consumers respond to DTCA by calling or visiting a health professional to discuss either medications or health problems. A sizeable minority ask for drugs by brand name. These products tend to be newer, more expensive ones where safety information may be incomplete because they are early in their life-cycles. Not only are consumers asking for such medications but in a substantial number of cases they are receiving them. If they do not receive them, then up to one-third of patients say they would switch doctors. Responding to these requests does not necessarily lead to greater patient satisfaction and may result in inappropriate prescribing. On the whole, it is likely that DTCA will have negative consequences for patient expectations of disease management. Patients may ask for and receive more expensive and newer products that have less well defined safety characteristics than older drugs. They may change doctors if they do not receive the medications that they request and transfer negative feelings about denial of therapy to the disease management setting. Good communication that is necessary for disease management may suffer. Finally, the clash between the expectations of both patients and doctors about how DTCA will affect the doctor-patient relationship may erode the patients' confidence in their physicians and the system they are working in.
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