title: Effects of Direct-To-Consumer Advertising on Patient Prescription Requests and Physician Prescribing: A Systematic Review of Psychiatry-Relevant Studies.
abstract: OBJECTIVE
  To systematically analyze the effects of direct-to-consumer advertising (DTCA) on patient requests for medication and physician prescribing across psychiatry-relevant studies.
  
  
  METHODS
  MEDLINE, PsycINFO, Thomson Reuters' ISI Web of Knowledge, and Google Scholar were searched (1999-2014) using variations of the terms direct-to-consumer advertising and psychiatric. Reference lists and an online repository of DTCA manuscripts were also scrutinized.
  
  
  METHODS
  English-language studies collecting data at the point of service, focusing on or including psychiatric medication, and assessing the effects of DTCA on patient and/or physician behavior were included. Of 989 articles identified, 69 received full-text review. Four studies across 5 manuscripts met inclusion criteria.
  
  
  METHODS
  Data were extracted on participants, study design, methodological quality, and results. Methodological quality of individual studies was assessed using adapted criteria from the Effective Public Health Practice Project. Confidence in conclusions across studies was determined using principles from the well-established GRADE system.
  
  
  RESULTS
  Due to lack of replication across strong randomized controlled trials (RCTs), no conclusions merited high confidence. With moderate confidence, we concluded that DTCA requests (1) are granted most of the time (1 RCT, 3 observational), (2) prompt higher prescribing volume (1 RCT, 1 observational), (3) promote greater adherence to minimally acceptable treatment guidelines for patients with depression (1 RCT), and (4) stimulate overprescribing among patients with an adjustment disorder (1 RCT).
  
  
  CONCLUSIONS
  Findings suggest that DTCA requests are typically accommodated, promote higher prescribing volume, and have competing effects on treatment quality. More methodologically strong studies are needed to increase confidence in conclusions.
authors.affiliation: Department of Behavioral and Social Sciences, Brown School of Public Health, 121 S Main St, 5th Fl, Providence, RI 02903. sara_becker@brown.edu.|Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA.|Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, Rhode Island, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Becker
authors.affiliation: Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA.
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Midoun
mesh_terms: D000275:Adjustment Disorders / Q000188:drug therapy / Q000523:psychology; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D000067088:Direct-to-Consumer Advertising; D019983:Guideline Adherence; D006801:Humans; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs; D011619:Psychotropic Drugs; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic
chemical_list: D055553:Prescription Drugs; D011619:Psychotropic Drugs