title: Direct-to-consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions.
abstract: OBJECTIVE
  Direct-to-consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions.
  
  
  METHODS
  We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures; the National Ambulatory/Hospital Medical Care Surveys (1997-2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS; and IMS Health's National Prescription Audit Plus (Fairfield, CT) to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data.
  
  
  RESULTS
  In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% confidence interval [CI], 0.5-1.6 million) and IBS diagnoses (by 397,025; 95% CI, 3909-790,141). Subsequently, the trend of visits and IBS diagnoses was reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4108 prescriptions (95% CI, 2526-5691).
  
  
  CONCLUSIONS
  The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and, in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (although not DTCA) correlated with tegaserod prescription volume.
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA. sdorn@med.unc.edu
authors.forename: Spencer D
authors.initials: SD
authors.lastname: Dorn
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
mesh_terms: D000329:Advertising / Q000379:methods*; D016208:Databases, Factual; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics / Q000639:trends*; D004363:Drug Utilization; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006293:Health Promotion; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D043183:Irritable Bowel Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D010358:Patient Participation / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D055656:Prescriptions / Q000706:statistics & numerical data; D011336:Probability
chemical_list: D005765:Gastrointestinal Agents; D007211:Indoles; C105050:tegaserod