公开披露药企向医师支付款项对患者信任的影响：一项随机实验
The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment.
机构信息
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
Harvard PhD Program in Health Policy and Harvard Medical School, Boston, MA, USA.
出版信息
J Gen Intern Med. 2017 Nov;32(11):1186-1192. doi: 10.1007/s11606-017-4122-y. Epub 2017 Jul 17.
BACKGROUND
Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties.
OBJECTIVE
The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry.
DESIGN
This was a randomized experimental evaluation.
PARTICIPANTS
There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study.
INTERVENTIONS
Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician.
MAIN MEASURES
Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust.
KEY RESULTS
Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry.
CONCLUSIONS
Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://clinicaltrials.gov/ct2/show/NCT02179632 ).
背景
医生与制药和医疗设备行业之间的财务联系很常见，但人们对这些联系如何影响患者的信任知之甚少。
目的
本研究旨在评估查看行业支付的在线公开披露如何影响患者对医生、医疗行业和制药及医疗设备行业的信任评级。
设计
这是一项随机实验评估。
参与者
共有 278 名年龄在 18 岁以上、在过去 12 个月内看过医疗保健提供者的讲英语的参与者参加了这项研究。
干预措施
参与者在在线披露数据库中搜索医生，查看行业向医生支付的款项，并给出信任评级。参与者被随机分配查看医生是否收到行业的零支付（$0）、低支付（$250-300）或高支付（>$13000），或在控制臂中不查看披露网站。他们还被要求搜索并对自己的医生的信任进行评级。
主要测量指标
主要结果是对个别医生、医疗行业和行业的信任。这些量表将信任作为诚实、忠诚、能力和整体信任的综合指标进行衡量。
结果
与未收到付款的医生相比，收到超过$13000 行业付款的医生在诚实方面的评分较低[平均值（标准差）：3.36（0.86）比 2.75（0.95），p<0.001]和忠诚度[3.19（0.65）比 2.89（0.68），p=0.01]。在网站上找到自己医生的 7.9%的参与者中，随着医生从行业获得的报酬增加，对诚实和忠诚的评级下降（诚实：Spearman 的 ρ=-0.52，p=0.02；忠诚：Spearman 的 ρ=-0.55，p=0.01）。查看披露网站并未影响对医疗行业或行业的信任评级。
结论
向医生披露行业支付款项会影响患者对医生个人诚实和忠诚的看法，但不会影响对医生能力的看法。披露对医疗行业或制药和医疗设备行业的信任评级没有影响。临床试验.gov 标识符：NCT02179632（https://clinicaltrials.gov/ct2/show/NCT02179632）。
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