Purpose: There is limited understanding of how physicians assess the effectiveness of prescription drug options and use that knowledge in their treatment decisions.
Method: We used a qualitative mental models research method to explore physicians’ perceptions of drug efficacy and effectiveness; how they use and interpret clinical efficacy information when making decisions; and how they communicate to their patients about effectiveness. We conducted 44 in-depth telephone interviews, averaging 55 minutes in length, with office-based physicians (23 rheumatologists and 21 general practitioners) across the United States. Thirty-two percent of respondents were female and 20% identified their race or ethnicity as being other than non-Hispanic white. The interviews focused respondents’ thinking on assessing and communicating about drugs to treat rheumatoid arthritis or psoriasis. Interviews were coded and analyzed to develop a graphical model of the key influences on respondents’ judgments and decisions regarding treatment effectiveness.
Result: The interviews revealed respondents' complex thinking on drug effectiveness. (a) Respondents believe that finding an effective treatment for a chronic condition is a process of “trial and error” and rely heavily on follow-up “global assessments” to evaluate the effectiveness of a prescribed treatment. (b) Respondents said that they balance the drug’s expected benefits, safety profile and the likelihood of patient compliance when assessing drug effectiveness before prescribing. (c) Respondents generally find expert assessments and treatment guidelines more relevant to their decisions than clinical efficacy and other statistical data. (d) When communicating to patients about effectiveness, a primary goal is to manage patients' expectations and comfort with the treatment decision, and thus respondents said they tailor communications according to their assessments of their patients’ prior beliefs about the condition or treatment, desire for information, ability to understand and comfort with the information.
Conclusion: Physicians need and desire clinically-relevant (“real-world”) and accessible information on drug effectiveness that enables tradeoffs among benefits, risks and costs. The research findings and resulting models can inform the development of guidance on how to provide physicians with the balanced and accessible information they need to make judgments and communicate with patients about drug effectiveness.
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