An integer programming model to limit hospital selection in studies with repeated sampling.

OBJECTIVE: We describe an integer programming model that, for studies requiring repeated sampling from hospitals, can aid in selecting a limited set of hospitals from which medical records are reviewed. STUDY SETTING: The model is illustrated in the context of two studies: (1) an analysis of the relationship between variations in hospital admission rates across geographic areas and rates of inappropriate admissions; and (2) a validation of computerized algorithms that screen for complications of hospital care. STUDY DESIGN: Common characteristics of the two studies: (1) hospitals are classified into categories, e.g., high, medium, and low; (2) the classification process is repeated several times, e.g., for different medical conditions; (3) medical records are selected separately for each iteration of the classification; and (4) for budgetary and logistical reasons, reviews must be concentrated in a relatively small subset of hospitals. DATA COLLECTION/EXTRACTION METHODS. In each study, hospitals are ranked based on analysis of hospital discharge abstract data. CONCLUSIONS: The model is useful for identifying a subset of hospitals at which more intensive reviews will be conducted.

A survey of aspirin use and Reye's syndrome awareness among parents.

A national telephone survey of 1,155 parents of children 19 years of age and younger solicited patterns of medication use during episodes of childhood flu and chicken pox. During the previous two years, 6 per cent of the parents whose children had chicken pox and 16 per cent of parents whose children had flu administered aspirin. Approximately 12 per cent of the total sample said they would give their child aspirin if their child were to get the flu or chicken pox today. About half (53 per cent) were aware of the contraindication against aspirin use and 40 per cent could spontaneously recall the name Reye's Syndrome (RS). When measured by a recognition test, 84 per cent of the sample said they had heard of RS. People who continued to believe that aspirin was an appropriate medication were more likely to have treated older children. The RS contraindication for aspirin should be emphasized for teenagers in future public informational programs.

Consumer attitudes about advertisements for medicinal drugs.

Approximately 1500 subjects were exposed to magazine or television advertisements for fictitious prescription drug products. The ads varied the way risk information was incorporated into the ad. Ads presented in the magazine, ads that contained detailed and specific descriptions of the drug's risks, and ads that used communications devices to emphasize risks (graphic subtitles or a separate announcer to read the risk material) were negatively evaluated. Television ads were more likely to lead subjects to state that they would consult a doctor about the medicine but not to be upset if the doctor refused to prescribe it. Evidently, television produced more positive but more tentative impressions about the product compared to the magazine. General risks informing people about the importance of the doctor in making prescribing decisions appeared to be reassuring. Older subjects had more positive views of the drug and the ad, were more receptive to the doctor's advice and were more concerned about the disease. The elderly may have viewed drugs as a symbol of health, whereas, younger subjects may have viewed them as a symbol of illness.

The attitudes of consumers toward direct advertising of prescription drugs.

Attitudes about prescription drug advertising directed to consumers were assessed in 1,509 persons who had viewed prototypical advertisements for fictitious prescription drug products. Although many subjects were generally favorable toward the concept of drug advertising directed to consumers, strong reservations were also expressed, especially about television advertising. Prescription drug advertising did not appear to undermine the physician's authority, since respondents viewed the physician as the primary drug decision-maker. However, the physician was not perceived as the sole source of prescription drug information. Television advertising appeared to promote greater information-seeking about particular drugs; however, magazine ads were more fully accepted by subjects. Furthermore, magazine ads led to enhanced views of the patient's authority in drug decision-making. The greater information conveyed in magazine ads may have given subjects more confidence in their own ability to evaluate the drug and the ad. Ads that integrated risk information into the body of the advertisement were more positively viewed than ads that gave special emphasis to the risk information. The results suggest that consumer attitudes about prescription drug advertising are not firmly held and are capable of being influenced by the types of ads people view. Regulation of such ads may need to be flexed to adapt to the way different media are used and processed by consumers.