RAND Corporation, Arlington, VA 22202, USA.
Med Care. 2011 Feb;49(2):132-8. doi: 10.1097/MLR.0b013e3181f81c63.
Both clinical guidelines and direct-to-consumer (DTC) advertising influence the use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the 2 strategies.
To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests.
Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women aged 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005.
Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in 2 groups of DTC cities (+5.57%, P < 0.0001; +2.54%, P < 0.0001). DTC advertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a cosponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β = 0.3347, P < 0.05 and β = 0.4175, P < 0.01).
DTC advertising was associated with increased overall use of a cervical cancer screening test, whereas clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services.
临床指南和直接面向消费者（DTC）的广告都会影响新的医疗保健技术的使用，但人们对它们的相对影响知之甚少。2000 年引入的宫颈癌筛查测试为评估这两种策略提供了独特的机会。
评估临床指南和有针对性的 DTC 广告活动对人乳头瘤病毒（HPV）DNA 检测的整体和适当使用的影响。
使用差异中的差异分析的准实验研究。数据来自 MarketScan 私人保险索赔，涉及 2001 年 1 月至 2005 年 12 月期间至少连续 12 个月参加的 500,000 名年龄在 21 至 64 岁的女性。
临床指南和 DTC 广告都与 HPV DNA 检测的整体使用增加有关。DTC 广告与 DTC 城市中的 HPV DNA 检测使用增加呈统计学显著相关（+5.57%，P <0.0001；+2.54%，P <0.0001）。DTC 广告与 HPV DNA 检测在初级筛查中适当和不适当使用的可能性增加相关。美国妇产科医师学会（American College of Obstetricians and Gynecologists）和一个联合赞助小组发布的临床指南与 HPV DNA 检测在适当的初级筛查中的使用增加相关，而不是在不适当的初级筛查中的使用增加相关（β=0.3347，P<0.05和β=0.4175，P<0.01）。
DTC 广告与宫颈癌筛查测试的整体使用增加有关，而临床指南与适当使用的增加有关。这些发现表明消费者营销和专业指南对医疗保健产品和服务的使用有明显的影响。
