Effects of patient medication requests on physician prescribing behavior: results of a factorial experiment.
BACKGROUND
Because of internet searches, advice from friends, and pharmaceutical advertising, especially direct-to-consumer advertising, patients are increasingly activated to request medications during a physician encounter.


OBJECTIVE
To estimate the effect of patient requests for medications on physician-prescribing behavior, unconfounded by patient, physician, and practice-setting factors.


METHODS
Two experiments were conducted among 192 primary care physicians, each using different video-based scenarios: an undiagnosed "patient" with symptoms strongly suggesting sciatica, and a "patient" with already diagnosed chronic knee osteoarthritis. Half of patients with sciatica symptoms requested oxycodone, whereas the other half requested something to help with pain. Similarly, half of knee osteoarthritis patients specifically requested celebrex and half requested something to help with pain.


METHODS
To increase generalizability and ensure sufficient numbers were available, we recruited 192 primary care physicians from 6 US states.


METHODS
The primary outcome was whether physicians would accede to a patient's request for a medication. Alternative pain medications prescribed were secondary outcomes.


RESULTS
19.8% of sciatica patients requesting oxycodone would receive a prescription for oxycodone, compared with 1% of those making no specific request (P = 0.001). Fifty-three percent of knee osteoarthritis patients requesting celebrex would receive it, compared with 24% of patients making no request (P = 0.001). Patients requesting oxycodone were more likely to receive a strong narcotic (P = 0.001) and less likely to receive a weak narcotic (P = 0.01). Patients requesting celebrex were much less likely to receive a nonselective nonsteroidal anti-inflammatory drugs (P = 0.008). No patient attributes, physician, or organizational factors influenced a physician's willingness to accede to a patient's medication request.


CONCLUSIONS
In both scenarios, activated patient requests for a medication substantially affected physician-prescribing decisions, despite the drawbacks of the requested medications.
*New England Research Institutes (NERI), Watertown †Division of Medicine, Harvard Medical School, Massachusetts General Hospital ‡Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School §Department of Epidemiology, Harvard School of Public Health ∥Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.
John B
JB
McKinlay
Felicia
F
Trachtenberg
Lisa D
LD
Marceau
Jeffrey N
JN
Katz
Michael A
MA
Fischer
D000368:Aged; D000068579:Celecoxib; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D020370:Osteoarthritis, Knee / Q000188:drug therapy; D010098:Oxycodone / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011720:Pyrazoles / Q000627:therapeutic use; D044469:Racial Groups / Q000706:statistics & numerical data; D012585:Sciatica / Q000188:drug therapy; D013449:Sulfonamides / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D009294:Narcotics; D011720:Pyrazoles; D013449:Sulfonamides; D010098:Oxycodone; D000068579:Celecoxib