Biernikiewicz M1, Taieb V2, Toumi M3
1Creativ-Ceutical, Cracow, Poland, 2Creativ-Ceutical, London, UK, 3Aix-Marseille University, Marseille, France
OBJECTIVES: Doctor-shopping involves visiting multiple doctors with the same health issue. It has significant consequences for patients and payers, as multiple consultations and overlapping prescriptions are often associated with abuse or misuse of drugs, polypharmacy, less continuity of care, and increased medical expenses. The aim of this study was to review the literature describing doctor-shoppers in the adult population. METHODS: A systematic literature review was performed in PubMed and supplemented by a Google search of grey literature. Overall, 2885 records were identified, out of which 43 were included in the analysis. The following data were extracted: definition of doctor-shopper, disease, treatment, patient characteristics, patient special needs, country. RESULTS: Definitions of doctor-shopping were heterogeneous. Overall, 40% of studies examined the use of strong, addictive drugs such as opioids, antidepressants, or psychoactive drugs, while the others included patients with chronic (e.g., diabetes, cancer, overactive bladder) or frequent disease (e.g., upper respiratory tract infections). Most studies were conducted in countries with easy access to health care resources (USA, France, Taiwan, Hong Kong). The prevalence of doctor-shopping ranged from 0.5% among opioid users in the USA to 25% of patients registered at general practices in Japan. Factors associated with doctor-shopping included comorbid mental disorders; history of opioid, alcohol, and other substance use disorders; greater distance between place of living and practitioner or pharmacy; younger age; longer time from diagnosis; additional comorbidities; and lower patient satisfaction. CONCLUSIONS: Knowing the characteristics of doctor-shoppers may help identify such patients and reduce the associated waste of medical resources, but concerns about the misuse of drug or health care resources should not prevent proper disease management. Further research is needed to cover a wider range of diseases and countries, and to examine the effect of health care regulations on doctor-shopping prevalence and costs.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Patient Behavior and Incentives