Choosing between apples and apples: physicians' choices of prescription drugs that have similar side effects and efficacies.
OBJECTIVE
To examine physician choices of commonly used medications having similar side effects and efficacies, and to evaluate factors that may affect these choices.


METHODS
Cross-sectional survey conducted in winter 1989-1990.


METHODS
263 physicians at a university teaching hospital (response rate = 71%).


RESULTS
Physicians rated patient compliance, cost to patient, and patient preference as the three most influential factors in their selection of a particular agent from a class of similar drugs. Housestaff were less likely than faculty to consider cost to patient as a "very important" factor (33% vs. 60%; p less than 0.05), and only 11% of all physicians felt that cost to third-party payer was very important. Physicians reported that their choices of particular nonsteroidal anti-inflammatory drugs (NSAIDs), histamine-2 (H2) blockers, and inhaled beta-agonists were mainly determined by which drugs enhanced compliance or were used by others (the "traditional choice"); cost to patient was a less important influence in these instances. All physician subgroups were inaccurate in predicting the approximate prices of their first- and second-choice agents. For example, only 28% of those selecting naproxen as their preferred NSAID were within $10 of the range of the prices of a one-month supply, and 14% were within $10 for cimetidine.


CONCLUSIONS
Although this group of physicians reported considering drug costs to be important when choosing between similar drugs, they acknowledged that cost was relatively unimportant in several specific instances studied and their knowledge of the absolute and relative prices of drugs they commonly prescribed was deficient.
Safavi
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Humana-Michael Reese Health Plan, Department of Internal Medicine, Chicago, Illinois.
Hayward
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RA
D000318:Adrenergic beta-Agonists; D000553:Ambulatory Care; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D016527:Drug Costs; D004363:Drug Utilization; D006635:Histamine H2 Antagonists; D006801:Humans; D010349:Patient Compliance; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment
D000318:Adrenergic beta-Agonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists