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What Do Plastic Surgery Patients Think of Financial Conflicts of Interest and the Sunshine Act?

Lopez, Joseph, MD, MBA*; Naved, Bilal A., BS; Pradeep, Tejus, BS*; Pineault, Kevin, BS*; Purvis, Taylor, BA*; Macmillan, Alexandra, MA (Catab) MBBS*; Slezak, Sheri, MD; May, James W. Jr, MD§; Dorafshar, Amir H., MBChB, FACS, FAAP*

doi: 10.1097/SAP.0000000000001756
Circumspectus Medicinae: Texts and Contexts
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Background The purpose of this study was to evaluate patients' views of conflicts of interest (COI) and their comprehension of recent legislation known as the Physician Payments Sunshine Act. This report constitutes the first evaluation of plastic surgery patients' views on COI and the government-mandated Sunshine Act.

Methods This cross-sectional study invited patients at an academic, general plastic surgery outpatient clinic to complete an anonymous survey. The survey contained 25 questions that assessed respondents' perceptions of physician COI and awareness of the Sunshine Act. Analyses were performed to examine whether perspectives on COI and the Sunshine Act varied by level of education or age.

Results A total of 361 individuals completed the survey (90% response rate). More than half of respondents with an opinion believed that COI would affect their physician's clinical decision-making (n = 152, 52.9%). Although almost three fourths (n = 196, 71.2%) believed that COI should be regulated and COI information reported to a government agency, the majority were not aware of the Sunshine Act before this survey (n = 277, 81.2%) and had never accessed the database (n = 327, 95.9%). More than half of patients (n = 161, 59.2%) stated that they would access a publicly available database with physicians' COI information. A larger proportion of older and educated patients believed that regulation of physicians' COI was important (P < 0.001).

Conclusions Awareness of and access to plastic surgeon COI information is low among plastic surgery patients. Older and more educated patients believed that transparency regarding COI is important with regard to their clinical care.

From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD;

Feinberg School of Medicine, Northwestern University, Chicago, IL;

Division of Plastic & Reconstructive Surgery, University of Maryland Medical Center, Baltimore, MD; and

§Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, MA.

Received August 1, 2018, and accepted for publication, after revision October 17, 2018.

J.L. and B.A.N. contributed equally to this work.

J.W.M. is a scientific consultant for Integra and an educational consultant for Johnson-Johnson – Mentor. A.D. receives research support and royalties from KLS Martin and research support from De Puy Synthes.

Conflicts of interest and sources of funding: This study was supported by the Department of Plastic and Reconstructive Surgery of the Johns Hopkins Hospital. The authors declare no conflict of interest.

Reprints: Joseph Lopez, MD, MBA, Department of Plastic Surgery, Johns Hopkins Hospital/University of Maryland Medical Center, 1780 E Fayette St Bloomberg 7th Flr, Rm 7314, Baltimore, MD 21231. E-mail: jlopez37@jhmi.edu.

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