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Evidence-based public health policy and practice
Physicians are more likely than non-physicians to use brand-name drugs to treat their chronic conditions
  1. Mariana Carrera1,
  2. Niels Skipper2
  1. 1 Department of Economics, Case Western Reserve University, Cleveland, Ohio, USA
  2. 2 Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Niels Skipper, Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark; nskipper{at}econ.au.dk

Abstract

Background Little is known about the treatments physicians choose for themselves compared with how they treat their patients. We determine if physicians prescribe different treatments to patients than to themselves.

Methods Population-based cohort study from 2004 to 2012 examining prescription claims of all Danish primary care physicians (PCP; n=3088) and all other Danish adults (n=2 334 590) who received a first-time prescription from a PCP for a statin (n=455 586), calcium channel blocker (CCB, n=330 369), serotonin-norepinephrine/selective serotonin reuptake inhibitors (SN/SSRIs, n=423 740), proton pump inhibitor (PPI, n=671 965) or antihistamine (n=456 018). The main outcome is the brand-name or generic status of the first prescribed drug. A logistic regression model compared outcomes, unadjusted and adjusted for sociodemographic characteristics and coverage information.

Results For drugs that require chronic treatment (statins, CCBs, SN/SSRIs), the relative risk (RR) for PCPs (PCP patients) being treated with a brand drug was 3.86 (95% CI 3.33 to 4.47; p<0.001). This difference remained significant when adjusting for covariates (adjusted RR=2.51 (95% CI 2.16 to 2.92; p<0.001)). For non-chronic drugs (PPIs, antihistamines), the RR for PCP patients was (RR=1.13 (95% CI 1.08 to 1.20; p<0.001)), and this difference was explained by higher income. Physicians are not more likely than non-physicians, however, to be treated with brand-name versions of drugs that are available as generics.

Conclusion Physicians are more likely than non-physicians to be treated with brand-name drugs without generic equivalents in three chronic treatment drug classes but not in two acute treatment drug classes. Guidelines can lead to lower brand-name drug use than physicians prefer for themselves.

  • prescribing
  • policy
  • primary care

https://doi.org/10.1136/jech-2016-208837

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    Footnotes

    • Contributors MC and NS contributed equally in the conception and design of the work, interpretation of the analysis, drafting the article, critical revision of the article and final approval of the version to be published. NS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Competing interests None declared.

    • Ethics approval Danish Data Protection Agency.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.