Table 1.

Summary of Results from Studies of DTCA Associated Prescribing which Report Appropriateness Measures

Ref	Methods	N	Exp to DTCA	DTCA-patient-MD interaction	Requestfulfilled	Appropriateness	Other outcomes	LOE
6	Physician survey	535	-	56% of 395 surveyed “last-recalled” DTCA conversations resulted in a request for DTCA-drug	77%	49% of fulfilled requests deemed inappropriate	Inaccurate advertisement, poor patient understanding of advertisement independently associated with inappropriate requests	III
7	Physician survey	643	-	643 “last-recalled” DTCA-drug conversations, request rate NR	39%	48% felt other drugs were equally effective but wanted to accommodate patient	Most common reasons for denial were cost and clinical considerations	III
8	Patient and physician survey	500	81%	4.5% of 944 surveyed visits for any reason were DTCA-drug-related, 51% recalled DTCA-drug requests	76%	NR, 46% reported no benefit of DTCA on patient interaction, 18% reported a negative effect	Most common reasons for not prescribing were clinical and cost considerations, followed by insufficient information from the advertisement	III
9	Case-control; outpatient DTCA visits compared with non-DTCA visits, patients and physicians surveyed	1431	94%	5.2% of 1431 surveyed visits for any reason were DTCA-drug-related	71% vs. 26% if no DTCA request (OR 16.9)	50% surveyed reported ambivalence about DTCA associated prescription	Strong dose-response relationship between the number of ads viewed and likelihood to request DTCA drug	II
10	Claims study; assessed appropriateness of COX-2 inhibitors prescription with clinical criteria	2929	80%	20% who viewed COX-2 advertising asked for a prescription	78% vs. 43% if no DTCA request	Fourfold, and sevenfold increase in inappropriate, and appropriate prescribing of COX-2 inhibitors, respectively	Specialist setting and increased age-associated with more appropriate prescription, female sex associated with inappropriate prescription	II
11	Randomized trial; SP’s portraying MDD or AD with or without DTCA-drug request, clinical appropriateness assessed	298	-	MDD: 101 DTCA-drug requests, 51 no request. AD: 98 DTCA-drug requests, 51 no request	MDD: 64% vs. 31% (OR: 8.0) AD: 47% vs. 10% (OR: 13.3)	“Minimal acceptable care” met more frequently (90–98% vs. 56%) in DTCA-request group for MDD, 34% inappropriate prescription rate in AD	Multivariate analysis: impact of DTCA-request on increasing prescription in AD much greater than that in MDD	I

Ref reference number, n total units of analysis, Exp to DTCA patient exposure to DTCA, DTCA direct to consumer advertising, LOE level of evidence, NR not reported, OR odds ratio, SP standardized patient, MDD major depressive disorder, AD adjustment disorder