ABSTRACT
Of 1,254 practicing physician assistants (PAs) who completed a survey, 91% were familiar with direct-to-consumer advertising (DTCA). When asked about their general perception, 96% of PAs were neutral or unfavorable towards DTCA. PAs felt that DTCA encouraged patients to make atypical medication requests, overlook the PA's medical opinion, and seek other health care providers.
This study sought to determine physician assistant (PA) attitudes toward direct-to-consumer advertising (DTCA) and to ascertain the effects of DTCA on the patient-PA relationship.
Design An 11-question Web-based survey was delivered to 15,656 PAs working in the five most common specialties as defined by the 2008 American Academy of Physician Assistants (AAPA) census.1 PAs were asked about specialty, years of experience, familiarity with DTCA, DTCA's targeted population, most common DTCA media outlet, and opinion of the beneficial and harmful effects of DTCA.
Results Eight percent of the PAs surveyed responded (n = 1,254). Participant specialties were as follows: family and general practice, 39%; general surgery and surgical subspecialties, 22%; general internal medicine, 23%; emergency medicine, 18%; and pediatric and pediatric subspecialties, 5%. Participants' experience ranged as follows: 0 to 5 years, 21%; 6 to 10 years, 26%; 11 to 15 years, 20%; and 16 or more years, 32% (Figure 1). The general perception of DTCA varied from favorable (4%) to neutral (38%) to unfavorable (58%) (Figure 2, Figure 3).
The benefits of DTCA selected included increased patient awareness (56%), increased patient awareness of disease signs and symptoms (51%), improved communication with patient (36%), increased patient office visits (13%), and increased patient satisfaction (6%); some PAs felt that DTCA had no effect (11%). PA perceptions of DTCA's disadvantages were that it brought atypical patient requests (76%), caused provider medical opinion to be overlooked (60%), strained the patient-provider relationship (33%), and led to ineffective use of scheduled time (26%); some respondents believed that DTCA had no negative effect (4%) (Figure 4).
Of PAs surveyed, 96% were neutral or did not favor DTCA (Table 1). The study identified the respondents who viewed DTCA unfavorably by practice: family and general practice, 38.9%; surgical specialties, 17%; internal medicine, 22.2%; emergency medicine, 16.9%; and pediatric specialties, 5%. Of the PAs who viewed DTCA neutrally, 35.8% were in family and general practice, 20.8% were in surgical specialties, 21.2% were in internal medicine, 17.2% were in emergency medicine, and 5% were in pediatric specialties. Most PAs surveyed perceived the age of the patient population most targeted by DTCA to be 46-64 years (70%), 31-45 years (15%), younger than 31 years (2%), and older than 65 years (13%). Television (92%) was identified as the most common media for DTCA, followed by print advertisements (6%), Internet (1%), and not sure (1%).
Discussion Pharmaceutical companies have spent substantial amounts of money on DTCA in an effort to maximize profits by bringing awareness of their products to the general population. The general public has been, and continues to be, consciously and unconsciously exposed to pharmaceutical DTCA through many media outlets. Patients are now more aware of medications than ever before. The PAs in this national study had similar responses to the survey questions, no matter what their years of experience or specialty. Their range of specialties and years of practice experience add credibility to the results.
Conclusion In this study, DTCA was perceived unfavorably by most PAs. Physician assistants and other prescribers should be aware of the dramatic influence of DTCA. Although PAs cannot prevent patients from seeking out other providers for care when denied medications requested as a result of DTCA, PAs can educate patients on the medications that they seek. The implications of the study will shed light on PA attitudes toward DTCA and help enhance understanding of the effects of advertisements on the public and on health care providers. Recommendations for further study include researching the cost effects of DTCA and how that affects health care costs and studying PA perceptions of DTCA by specific geographical location to determine differences in opinion by location. jaapa
Richard Dehn, MPA, PA-C, DFAAPA,
department editor
The authors are affiliated with the New York Institute of Technology (NYIT) in Old Westbury, New York. Justin Anzalone, Asha Mathews, and Michael Suprenant were students in the PA program when this research was conducted. Lawrence Herman is an associate professor and Director of Primary Care Initiatives at the NYIT PA program. The authors have indicated no relationships to disclose relating to the content of this article.
REFERENCE
1. American Academy of Physician Assistants. 2008
AAPA physician assistant census report. http://www.
aapa.org/uploadedFiles/content/Common/Files/
2008aapacensusnationalreport.pdf. Accessed January 11, 2012.