Advertisement-Induced Prescription Drug Requests Patients' Anticipated Reactions to a Physician Who Refuses

Journal of Family Practice, June, 1999 by Robert A. Bell, Michael S. Wilkes, Richard L. Kravitz

PREDICTOR VARIABLES

Physician communication quality. The respondent's evaluation of his or her physician's communication quality (CQ) was assessed using 5 items selected from the patient satisfaction questionnaire developed by the American Board of Internal Medicine. The alpha reliability[22] for this sample was .93. Because an evaluation of physician communication quality could only be made by respondents who had a regular physician, we created a hybrid categorical relationship quality variable for our multivariate analyses as follows: (1) respondents reporting that they did not have a regular physician were assigned to the "no established relationship" category (17%); (2) individuals in approximately the lowest third on the CQ distribution were assigned to the [relative] "poor relationship" category (29%); (3) those who fell approximately into the middle third were assigned to the "average relationship" category (26%); and (4) those in the top third were assigned to the "positive relationship" category (28%).

Attitudes, beliefs, and behavior. The variable attitude toward DTC advertising was assessed with 4 items. Respondents were asked if DTC advertisements: provide consumers with valuable information about medical treatments; carefully describe both the risks and benefits of these drugs; are deceptive; and are something of which they disapprove. Responses were made on a 5-point Likert-type scale where 1 = strongly agree and 5 = strongly disagree. After determining through factor analysis that these items were unidimensional, an attitude score was computed for each respondent by averaging across the 4 items (after reverse-scoring the 2 positively worded items). Thus, higher scores indicated a more positive sentiment. This scale had a range of 1 to 5 and an alpha reliability of .74.

We assessed faith in regulation with 4 true or false statements about government supervision of DTC advertisements: (1) drug companies must submit copies of all prescription drug advertisements to the federal government for approval before those advertisements are used; (2) only prescription drugs that have been found to be completely safe can be advertised in the United States; (3) only prescription drugs that have been found to be extremely effective can be advertised in the United States; and (4) the advertising of prescription drugs that have serious side effects has already been banned in the United States. Respondents were asked to indicate if each statement was true or false (the correct answer to all 4 statements is "false"). We then computed a composite score for each respondent by counting the number of items judged to be true (range = 0 to 4); thus, higher scores indicated a greater misplaced confidence in government regulation of DTC advertising. The alpha reliability of this measure was .53; this modest value reflects the small number of items composing the scale, as well as the dichotomous form of subjects' responses to these items.[22]

Two single-item behavioral indicators of people's feelings about DTC advertising were also included as independent variables. Respondents were asked to indicate if they had ever requested more information about a drug, or asked for a prescription, as a result of a DTC advertisement.