title: Lack of impact of direct-to-consumer advertising on the physician-patient encounter in primary care: a SNOCAP report.
abstract: OBJECTIVE
  Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their influence on clinical encounters in primary care.
  
  
  METHODS
  Our methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters.
  
  
  RESULTS
  One hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specific new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P<.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their first choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%.
  
  
  CONCLUSIONS
  Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specific socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.
authors.affiliation: Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA. Bennett.Parnes@uchsc.edu
authors.forename: Bennett
authors.initials: B
authors.lastname: Parnes
authors.forename: Peter C
authors.initials: PC
authors.lastname: Smith
authors.forename: Christine
authors.initials: C
authors.lastname: Gilroy
authors.forename: Javan
authors.initials: J
authors.lastname: Quintela
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Emsermann
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: John M
authors.initials: JM
authors.lastname: Westfall
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004345:Drug Industry; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019370:Observation; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000008:administration & dosage; D011320:Primary Health Care; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D055553:Prescription Drugs