Patient requests affect clinician prescribing behavior

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Patient Request Impacts Doc Prescribing Behavior
Patient Request Impacts Doc Prescribing Behavior

(HealthDay News) -- Patients requesting specific medications are more likely to be prescribed those medications, according to research published in the April issue of Medical Care.

John B. McKinlay, Ph.D., from the New England Research Institutes in Watertown, Mass., and colleagues estimated the effect of patient requests for medications on physician prescribing behavior. Two experiments, using video-based scenarios, were conducted among 192 primary care physicians from six states. In one scenario, an undiagnosed patient with symptoms indicating sciatica requested oxycodone or something to help with pain. In a second scenario, a patient with already diagnosed chronic knee osteoarthritis requested Celebrex or something to help with pain.

The researchers found that, for the sciatica patients, 19.8 percent of those requesting oxycodone and 1 percent of those making no specific request would receive a prescription for oxycodone (P = 0.001). Of the patients with knee osteoarthritis, 53 percent of those requesting Celebrex and 24 percent of those not requesting it specifically would receive a prescription for Celebrex (P = 0.001). Patients who requested oxycodone were more and less likely to receive a strong and weak narcotic, respectively (both P = 0.001). The likelihood of receiving a nonselective nonsteroidal anti-inflammatory drug was lower for patients requesting Celebrex (P = 0.008). A physician's willingness to accede to a patient's medication request was not influenced by patient attributes, physician, or organizational factors.

"In both scenarios, activated patient requests for a medication substantially affected physician prescribing decisions, despite the drawbacks of the requested medications," the authors write.

One author disclosed financial ties to CVS Caremark.

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