Consumer drug ads create brand name demand

Hype runs head-on into managed care cost issues

If you feel as though your patients are deluging you with requests for specific brand-name drugs, you're not alone. Physicians are experiencing a groundswell of patient interest in drugs advertised on television and in magazines.

No longer are pharmaceutical products mysterious, little known concoctions to patients. No longer are drug ads tucked away in physician journals. Instead, colorful, action-oriented drug ads appear front and center just about everywhere you go, from women's magazines to sports journals.

Why are patients so bombarded? And how do you deal with mounting consumer pressure combined with managed care pressures to keep drug costs under control? While the ad market deluges your patients, the managed care market is deluging the medical industry with other concerns.

This description from U.S. News & World Report puts it in perspective: "The tidal wave of managed care is now crashing down on the huge U.S. prescription drug industry. Changes have created a chaotic pharmaceutical marketplace characterized by fierce competition, aggressive sales practices, and vast implications for consumers and businesses. Pharmacists and doctors can be under heavy pressure to switch patients and prescriptions to preferred products, and professionals who don't cooperate are subject to reprisals."1

That's the same environment described by many physicians and administrators contacted by Physician's Managed Care Report. (For details on current strategies for management of capitated pharmacy contracts and the financial pressures associated with those contracts, see PMCR, February 1998, pp. 17-22.) "If you can tell us how to deal with this, we'd be very excited to read about it," says Kristen Sutek, director of public affairs at Scott and White Clinic in Temple, TX, paraphrasing her conversations with several physicians regarding suggestions for this article. Even doctors at this well-respected group practice say they're struggling with how to deal with countervailing pressures to be cost-conscious and outcome-driven regarding drugs, while at the same time being respectful of patient demand. (See related story, below, for an objective question-and-answer handout you can copy to give to patients.)

Other physicians concur. "It's difficult," says Douglas Lee, MD, medical director of Security Health System, the HMO of Marshfield (WI) Clinic. Marshfield has 520 participating physicians in its clinic-owned HMO. "They see ads based on a product rather than a patient problem," Lee explains. Heart disease is a common example, used both by Lee and Yank Coble, MD, an intern ist in Jacksonville, FL, and board member of the Chicago-based American Medical Society.1

For doctors seeing patients day to day, it takes more than a "just say no" approach to patients who request a specific name-brand drug, experts say. Here are some suggestions from Lee and others on how to handle patient drug prescription concerns:

· Increase patient education. The material on p. 75 can help introduce patients to issues in advertising and managed care. You may also want to offer it to your major insurers for use in their newsletters for enrollees.

· Try to keep discussions from getting heated or argumentative. When patients present to you with the main mission of obtaining a prescription, try to figure that out as soon as you can so you can prevent a tug-of-war from starting, advises Barry E. Egener, MD, an internist and medical director of the Northwestern Physician-Patient Communication Center in Portland, OR. Egener addressed these issues at the 1998 annual meeting of the American College of Physicians, held recently in San Diego.2

In this situation, the process - not the content - of what you say is most important, Egener advises. He suggests four key steps:

1. Address the patient's emotions rather than combating them.

2. Avoid becoming defensive.

3. Share control with the patient, rather setting up a power struggle.

4. Focus on the patient's ability to function, not the patient's pain.

For many patients, the pain will never go away, he says. Focus instead on helping them function.

He also sets out these steps as a basis for negotiation:

- Talk to the patient and identify why the patient is there. Ask for the patient's point of view on his or her drug needs.

- Establish common goals.

- Set limits regarding what you believe is appropriate drug use and what is not.

· Let patients know when drug prescriptions are made based on practice guidelines and other expert recommendations. Often physicians prescribe medications based on the guidance of professional practice guidelines, Lee notes. These guidelines can be either nationally developed; they can stem from practice committees and leadership; or they can be a combination of both. Patients often believe that drug decisions are purely that of their physician. While this can be the case, many times the choice is based on the leadership and experience of many physicians. Knowing that can help patients see why one advertisement may not be the best option given the broader view of physicians dealing with the issues from day to day.

References

1. For more details, see coverage of Barry Egener's presentation on the Internet at the Web site of the American College of Physicians: www.acp.org.

2. Yank Coble, MD, was featured on the issues of drug advertising and managed on a recent broadcast of National Public Radio. Also, he discusses the topic in American Demographics, January 1998. The magazine article is available on the Internet at www.demographics.com.