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Patients' distrust of the drug industry's influence on doctors and other beliefs may affect drug adherence

From 20 to 50 percent of patients do not take prescribed medications as their doctors recommend. Two factors may influence acceptance of a doctor's recommendation, according to a new study. Researchers found that many patients are concerned about the drug industry's influence (via gifts and other incentives) on doctors' prescribing practices. Also, many believe that there is a clear "best" medication for most health problems, even though there is often no clear evidence for one treatment choice over another (equipoise). The study's findings suggest a need to examine how doctors' relationships with pharmaceutical representatives affect patient trust and medication adherence and how patients' understanding of equipoise affects medication adherence.

Researchers at the HMO Research Network Center for Education and Research on Therapeutics (CERT) interviewed 50 members of 2 Massachusetts health plans about beliefs and preferences about doctors' medication recommendations. Participants were asked several questions after listening to an audio vignette of a doctor prescribing a new drug for either depression or hypertension to a patient. The questions addressed how participants felt the patient-doctor relationship, outside influences, and the doctor's expertise affected the doctor's decision to recommend a medication.

Trust in and good communication with the doctor was associated with greater likelihood of following the medication recommendation. However, concerns about gifts and other financial incentives from pharmaceutical companies to the doctors appeared to threaten participants' trust in doctors' recommendations.

Participants believed doctors knew the "best" drug for their clinical situation, even though sometimes different drugs are equally effective for the same condition. In these cases, doctors could discuss possible cheaper generic drugs with patients, especially since participants said they wanted to be involved in drug cost decisions.

The study was supported by the Agency for Healthcare Research and Quality through a supplement to the HMO Research Network CERT (HS10391). For more information on the CERTs program, go to http://www.ahrq.gov

See "Patients' beliefs and preferences regarding doctors' medication recommendations," by Sarah L. Goff, M.D., Kathleen M. Mazor, Ph.D., Vanessa Meterko, B.S., and others in the March 2008 Journal of General Internal Medicine 23(3), pp. 236-241.

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