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Nam K, Cho DSH, Kim H, Kwon B, Yoon Y, Park C, Kim ES, Youn JC, Park SK. Systematic Review of the Economic Evaluation of Sodium-Glucose Cotransporter-2 Inhibitors Used as Treatment in Patients with Heart Failure. Clin Drug Investig 2023; 43:463-474. [PMID: 37365452 DOI: 10.1007/s40261-023-01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been recently used as therapeutic agents for type 2 diabetes mellitus. Recent clinical trials have shown that they are beneficial for reducing the risk of cardiovascular mortality and hospitalization in patients with heart failure (HF). A comprehensive review regarding the cost-effectiveness of different SGLT2 inhibitors for HF treatment may be necessary to help clinicians and decision-makers select the most cost-effective HF treatment option. OBJECTIVE This study conducted a systematic review of economic evaluation studies of SGLT2 inhibitors for the treatment of patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). METHOD We searched PubMed, Cochrane, Embase, and EBSCOhost to identify published economic evaluation studies on SGLT2 inhibitors for HF treatment until May 2023. Studies on the economic evaluation of SGLT2 inhibitors in the treatment of HF were included. We extracted information such as country, population, intervention, type of model, health status, and conclusion of cost-effectiveness. RESULT Of the 410 studies, 27 were finally selected. All economic evaluation studies used the Markov model, and commonly included health status as stable HF, hospitalization due to HF, and death. All dapagliflozin studies focused on patients with HFrEF (n = 13), and dapagliflozin was cost-effective in 14 countries, but not in the Philippines. All empagliflozin studies focused on the patients with HFrEF also showed the cost-effectiveness of empagliflozin (n = 11). However, empagliflozin use in patients with HFpEF was determined to be cost-effective in studies in Finland, China, and Australia studies but not in studies in Thailand and the USA. CONCLUSIONS Most of the studies reported the cost-effectiveness of dapagliflozin and empagliflozin in patients with HFrEF. However, the cost-effectiveness of empagliflozin differed from country to country regarding patients with HFpEF. We suggest that further economic evaluation of SGLT2 inhibitors should focus on patients with HFpEF in more countries.
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Affiliation(s)
- Kyungae Nam
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea
| | - Daniel Sung-Ho Cho
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea
| | - Hyunji Kim
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea
| | - Byungjin Kwon
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea
| | - Yebin Yoon
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Eui-Soon Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Korea.
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Everson J, Henderson SC, Cheng A, Senft N, Whitmore C, Dusetzina SB. Demand for and Occurrence of Medication Cost Conversations: A Narrative Review. Med Care Res Rev 2023; 80:16-29. [PMID: 35808853 DOI: 10.1177/10775587221108042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations (n = 7 articles) but only 23% reported having held a cost conversation across six specialties (n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.
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Affiliation(s)
- Jordan Everson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Audrey Cheng
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Stacie B Dusetzina
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Garcia JF, Peters AL, Raymond JK, Fogel J, Orrange S. Equity in Medical Care for People Living With Diabetes. Diabetes Spectr 2022; 35:266-275. [PMID: 36082008 PMCID: PMC9396720 DOI: 10.2337/dsi22-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disparities and inequities exist for individuals with diabetes in marginalized communities of color, especially among people with low socioeconomic status. Although these barriers are apparent, only a few care models have been designed for and examined in racially and ethnically diverse individuals. This article reviews models that have been developed and examined in a variety of different populations and focuses on how to implement elements from these programs in clinical practice. Health equity-promoting ideas and approaches that can be applied throughout the life span (children to seniors) are also included. As diabetes health care providers, researchers, educators, policymakers, and advocates, we must now combine our efforts and focus on historically excluded populations to bridge the gap to essential diabetes care.
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Affiliation(s)
| | | | | | | | - Sharon Orrange
- University of Southern California, Los Angeles, CA
- Corresponding author: Sharon Orrange,
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Kennedy J, Tuleu I, Mackay K. Unfilled Prescriptions of Medicare Beneficiaries: Prevalence, Reasons, and Types of Medicines Prescribed. J Manag Care Spec Pharm 2020; 26:935-942. [PMID: 32715958 PMCID: PMC10391240 DOI: 10.18553/jmcp.2020.26.8.935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the proven efficacy of prescription regimens in reducing disease symptoms and preventing or minimizing complications, poor medication adherence remains a significant public health problem. Medicare beneficiaries have high rates of chronic illness and prescription medication use, making this population particularly vulnerable to nonadherence. Failure to fill prescribed medication is a key component of nonadherence. OBJECTIVES To (1) determine the rates of self-reported failure to fill at least 1 prescription among a sample of Medicare beneficiaries in 2004, (2) identify the reasons for not filling prescribed medication, (3) examine the characteristics of Medicare beneficiaries who failed to fill their prescription(s), and (4) identify the types of medications that were not obtained. METHODS The study is a secondary analysis of the 2004 Medicare Current Beneficiary Survey (MCBS), an ongoing national panel survey conducted by the Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries living in the community (N = 14,464) were asked: "During the current year [2004], were there any medicines prescribed for you that you did not get (please include refills of earlier prescriptions as well as prescriptions that were written or phoned in by a doctor)?" Those who responded "yes" to this question (n = 664) were asked to identify the specific medication(s) not obtained. Rates of failure to fill were compared by demographic and income categories and for respondents with versus without self-reported chronic conditions, identified by asking respondents if they had ever been told by a doctor that they had the condition. Weighted population estimates for nonadherence were calculated using Professional Software for SUrvey DAta ANalysis for Multi-stage Sample Designs (SUDAAN) to account for the MCBS multistage stratified cluster sampling process. Unweighted counts of the prescriptions not filled by therapeutic class were calculated using Statistical Analysis Software (SAS). RESULTS In 2004, an estimated 1.6 million Medicare beneficiaries (4.4%) failed to fill or refill 1 or more prescriptions. The most common reasons cited for failure to fill were: "thought it would cost too much" (55.5%), followed by "medicine not covered by insurance" (20.2%), "didn't think medicine was necessary for the condition" (18.0%), and "was afraid of medicine reactions/contraindications" (11.8%). Rates of failure to fill were significantly higher among Medicare beneficiaries aged 18 to 64 years eligible through Social Security Disability Insurance (10.4%) than among beneficiaries aged 65 years or older (3.3%, P < 0.001). Rates were slightly higher for women than for men (5.0 vs. 3.6%, P = 0.001), for nonwhite than for white respondents (5.5% vs. 4.2%, P = 0.010), and for dually eligible Medicaid beneficiaries than for those who did not have Medicaid coverage (6.3% vs. 4.0% P = 0.001). Failure-to-fill rates were significantly higher among beneficiaries with psychiatric conditions (8.0%, P < 0.001); arthritis (5.2%, P < 0.001); cardiovascular disease (5.2%, P = 0.003); and emphysema, asthma, or chronic obstructive pulmonary disease (6.6%, P < 0.001) than among respondents who did not report those conditions, and the rate for respondents who reported no chronic conditions was 2.5%. Rates were higher for those with more self-reported chronic conditions (3.2%, 4.0%, 4.3%, and 5.9% for those with 1, 2, 3, and 4 or more conditions, respectively, P < 0.001). Among the prescriptions not filled (993 prescriptions indentified by 664 respondents), central nervous system agents, including nonsteroidal anti-inflammatory drugs, were most frequently identified (23.6%, n = 234), followed by cardiovascular agents (18.3%, n = 182) and endocrine/metabolic agents (6.5%, n = 65). Of the reported unfilled prescriptions, 8.1% were for antihyperlipidemic agents, 5.4% were for antidepressant drugs, 4.6% were for antibiotics, and 29.9% were for unidentified therapy classes. CONCLUSION Most Medicare beneficiaries fill their prescriptions, but some subpopulations are at significantly higher risk for nonadherence associated with unfilled prescriptions, including working-age beneficiaries, dual-eligible beneficiaries, and beneficiaries with multiple chronic conditions. Self-reported unfilled prescriptions included critical medications for treatment of acute and chronic disease, including antihyperlipidemic agents, antidepressants, and antibiotics. DISCLOSURES This study was funded by the U.S. Department of Education's National Institute on Disability and Rehabilitation Research, Field Initiated Research Grant H133G070055. However, the analysis and the interpretation of these findings do not necessarily represent the policy of the Department of Education and are not endorsed by the federal government. All authors contributed approximately equally to the study concept and design. Tuleu performed the majority of the data collection, with assistance from Kennedy. Kennedy interpreted the data, with assistance from Tuleu and Mackay. Kennedy and Mackay wrote the majority of the manuscript, with assistance from Tuleu. Kennedy made the majority of the changes in revision of the manuscript.
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Affiliation(s)
- Jae Kennedy
- An Associate Professor in the Department of Health Policy and Administration at Washington State University
| | - Iulia Tuleu
- An Internal Medicine Resident at Beaumont Hospital in Royal Oak, Michigan
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Warth J, Puth MT, Zier U, Beckmann N, Porz J, Tillmann J, Weckbecker K, Bosma H, Weltermann B, Münster E. Patient-physician communication about financial problems: A cross-sectional study among over-indebted individuals. PLoS One 2020; 15:e0232716. [PMID: 32369528 PMCID: PMC7199951 DOI: 10.1371/journal.pone.0232716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background About every tenth household across Europe is unable to meet payment obligations and living expenses on an ongoing basis and is thus considered over-indebted. Previous research suggests that over-indebtedness reflects a potential cause and consequence of psychosomatic health problems and limited access to care. However, it is unclear whether those affected discuss their financial problems with general practitioners. Therefore, this study examined patient-physician communication about financial problems in general practice among over-indebted individuals. Methods We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017. We assessed the prevalence of patient-physician communication about financial problems and its association with patient characteristics using descriptive statistics and logistic regression analysis. Of 699 individuals who returned the questionnaire (response rate:50.2%), we included 598 respondents enrolled in statutory health insurance with complete outcome data in the analyses. Results Conversations about financial problems with general practitioners were reported by 22.6% (n = 135) of respondents. Individuals with a high educational level were less likely to report such conversations than those with medium educational level (aOR 0.11; 95%CI 0.01–0.83) after adjustment for other sociodemographic characteristics, health status and measures of financial distress. Those without a migrant background(aOR 2.09; 95%CI 1.32–3.32), the chronically ill(aOR 1.90; 95%CI 1.16–3.13) and individuals who reported high financial distress(aOR 2.15; 95%CI 1.22–3.78) and cutting on necessities to pay for medications(aOR 1.86; 95%CI 1.12–3.09) were more likely to discuss financial problems than their counterparts. Conclusions Few over-indebted individuals discussed financial problems with their general practitioner. Patients’ health status, coping strategies and perception of financial distress might contribute to variations in disclosure of financial problems. Thus, enhancing communication and screening by routine assessment of financial problems in clinical practice can help to identify vulnerable patients and promote access to health care and social services and well-being for all.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
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Jimenez DE, Schmidt AC, Kim G, Cook BL. Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults. Int J Geriatr Psychiatry 2017; 32:909-921. [PMID: 27363866 PMCID: PMC7734612 DOI: 10.1002/gps.4546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need. METHODS Data were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+ years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need. RESULTS Racial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos. CONCLUSIONS Expenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Daniel E. Jimenez
- Center on Aging and Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew C. Schmidt
- Center on Aging and Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giyeon Kim
- Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Benjamin Le Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA
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Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes: Findings From the National Health Interview Survey. Med Care 2017; 54:796-803. [PMID: 27219636 DOI: 10.1097/mlr.0000000000000565] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non-health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN. METHODS Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN. RESULTS Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05-1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5-1.67), and food insecurity (PR=1.30; 95% CI, 1.2-1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2-0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. CONCLUSIONS Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
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Abstract
BACKGROUND Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. METHODS This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants' FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher's exact test, and multiple regression analyses were used to analyze the data. RESULTS The mean score of the total FHL was 7.72±3.51 (range 0-15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient's degree of satisfaction with the service (β=-0.215, P=0.022), sufficient explanation of medication counseling (β=-0.335, P=0.000), education level (β=-0.153, P=0.045), health-related problems (β=-0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). CONCLUSION In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients' individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling.
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Affiliation(s)
| | - Yeonhee Kim
- Center for Excellence in Teaching & Learning
| | - Sandy Jeong Rhie
- College of Pharmacy
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Correspondence: Sandy Jeong Rhie, College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea, Tel +82 2 3277 3023, Fax +82 2 3277 2851, Email
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Physician-patient communication on cost and affordability in asthma care. Who wants to talk about it and who is actually doing it. Ann Am Thorac Soc 2015; 11:1538-44. [PMID: 25375395 DOI: 10.1513/annalsats.201408-363oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
RATIONALE Patient perceptions of financial burden and rates of cost-related nonadherence are high among individuals with asthma across the socioeconomic spectrum. Little is known about preferences and frequency of physician-patient discussions about cost/affordability among individuals managing respiratory conditions. OBJECTIVES To examine who has a preference to discuss the cost of their asthma care with their physician, how often physician-patient communication about cost/affordability actually is occurring, and what clinical and demographic characteristics of patients are predictive of communication. METHODS Data came from 422 African American adult women with asthma who were asked about communication preferences and practices around cost and affordability with their physician. Data were analyzed using descriptive statistics and multiple variable logistic regression models. MEASUREMENTS AND MAIN RESULTS Fifty-two percent (n = 219) of this sample perceived financial burden. Seventy-two percent (n = 300) reported a preference to discuss cost with their health-care provider. Thirty-nine percent (n = 163) reported actually having a conversation with their physician about cost. Among the 61% who reported no discussion, 40% (n = 103) reported financial burden, and 55% (n = 140) reported a preference for discussion. Lower household income (P < 0.001), perception of financial burden (P < 0.001), and higher out-of-pocket expenses for medicines (P < 0.05) were significantly predictive of greater preference to communicate about cost/affordability with the doctor when adjusted for clinical and demographic characteristics. Perception of financial burden (P < 0.001), preference to discuss affordability (P < 0.001), and greater number of chronic conditions (P < 0.001) were significantly predictive of greater likelihood of communication about cost/affordability with the doctor when adjusted for clinical and demographic characteristics. Bivariate analyses revealed that patients who reported a discussion of cost were more likely to report worse asthma control and lower asthma-related quality of life. CONCLUSIONS An imbalance is evident between patients who would like to discuss cost with their doctor and those who actually do. Patients are interested in low-cost options and a venue for addressing their concerns with a care provider; therefore, a greater understanding is needed in how to effectively and efficiently integrate these conversations and viable solutions into the delivery of health care. Additional research is necessary to determine whether communication about the cost of therapy is associated with health outcomes.
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Simon-Tuval T, Triki N, Chodick G, Greenberg D. Determinants of Cost-Related Nonadherence to Medications among Chronically Ill Patients in Maccabi Healthcare Services, Israel. Value Health Reg Issues 2014; 4:41-46. [PMID: 29702805 DOI: 10.1016/j.vhri.2014.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of value-based insurance design is based on nonadherence, which derives solely from patients' economic constraints. OBJECTIVE Our objective was to examine the extent of cost-related nonadherence to chronic medications and to analyze its potential determinants. METHODS We conducted a telephone survey among a representative sample of Maccabi Healthcare Services chronically ill patients aged 55 years or older (n = 522). We developed a 12-month recall questionnaire that included demographic and socioeconomic characteristics, out-of-pocket expenditure on prescribed medication, physician's provision of explanation regarding prescribed therapy, adherence, and reasons for nonadherence. Respondents were defined as nonadherent if they reported that they did not purchase prescribed medications in the previous year because of their cost. We applied the multivariable logistic regression model to examine predictors of nonadherence. RESULTS Median (interquartile range) age of the study sample was 69 (13) years (53% males). One hundred sixty-five patients (31.6%) reported not purchasing prescribed medications mainly because of medications' adverse effects and/or cost. Fifty respondents (9.6%) reported cost-related nonadherence. The multivariable logistic regression model revealed that cost-related nonadherence was associated with respondent's income lower than 4600 New Israeli shekel (odds ratio [OR] = 10.86; 95% confidence interval [CI] 1.45-81.12), unemployment (OR = 4.32; 95% CI 1.47-12.66), lack of physician explanation about the prescribed medication (OR = 2.38; 95% CI 1.18-4.78), and age (OR = 0.95; 95% CI 0.91-0.99). CONCLUSIONS Cost-related nonadherence to chronic pharmaceuticals is self-reported among nearly 10% of the chronically ill patients and is strongly affected by low socioeconomic status, even under universal health insurance coverage and with relatively low co-payments as applied in Israel. Lack of information provided by physicians regarding the therapy is associated with a higher likelihood of cost-related nonadherence.
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Affiliation(s)
- Tzahit Simon-Tuval
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Noa Triki
- Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Patel MR, Nelson BW, Id-Deen E, Caldwell CH. Beyond co-pays and out-of-pocket costs: perceptions of health-related financial burden in managing asthma among African American women. J Asthma 2014; 51:1083-8. [PMID: 24945886 DOI: 10.3109/02770903.2014.936453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to define perceptions of health-related financial burden based on the views of individuals who report these perceptions through qualitative approaches. METHODS Four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview was employed by facilitators. Coded transcripts were analyzed for themes regarding dimensions of the meaning of financial burden. RESULTS Major domains of financial burden identified included (1) high out-of-pocket expenses; (2) lost wages from exacerbations, inability to maintain a stable job and stress from making decisions about taking a sick day or coming to work; (3) transport costs; (4) both costs and stress of managing insurance eligibility and correcting erroneous bills. CONCLUSION Greater awareness of factors that add to perceptions of financial burden might better equip researchers to develop interventions to help care teams manage such concerns with their patients.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health , Ann Arbor, MI , USA and
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Bodenmann P, Favrat B, Wolff H, Guessous I, Panese F, Herzig L, Bischoff T, Casillas A, Golano T, Vaucher P. Screening primary-care patients forgoing health care for economic reasons. PLoS One 2014; 9:e94006. [PMID: 24699726 PMCID: PMC3974836 DOI: 10.1371/journal.pone.0094006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources. OBJECTIVES Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation. DESIGN Multicenter cross-sectional survey. PARTICIPANTS Forty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices. MAIN MEASURES Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels. KEY RESULTS Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R(2) = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times. CONCLUSION General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.
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Affiliation(s)
- Patrick Bodenmann
- Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Hans Wolff
- Department of Community Medicine, Primary Care, and Emergency Medicine, University Hospital Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Department of Community Medicine, Primary Care, and Emergency Medicine, University Hospital Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Francesco Panese
- Institute of the History of Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Lilli Herzig
- Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Thomas Bischoff
- Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alejandra Casillas
- Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Thomas Golano
- Institute of General Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- Institute of Legal Medicine, School of Medicine, University of Geneva, Geneva, Switzerland
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Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013; 15:e286. [PMID: 24351420 PMCID: PMC3875904 DOI: 10.2196/jmir.2914] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. OBJECTIVE To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. METHODS Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. RESULTS All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running. CONCLUSIONS Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.
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Affiliation(s)
- Masahito Jimbo
- University of Michigan, Departments of Family Medicine and Urology, Ann Arbor, MI, United States.
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Omojasola A, Hernandez M, Sansgiry S, Paxton R, Jones L. Predictors of $4 generic prescription drug discount programs use in the low-income population. Res Social Adm Pharm 2013; 10:141-8. [PMID: 23684716 DOI: 10.1016/j.sapharm.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Generic drug discount programs (GDDPs) are an option to provide affordable prescription medication to low-income individuals. However, the factors that influence the use of GDDPs in low-income population are unknown. OBJECTIVES To evaluate factors associated with utilization of generic a drug discount program in a low-income population. METHODS A survey was administered to adult participants at health centers and community-based organizations in Houston, Texas, USA (n = 525). Exploratory factor analysis was conducted to determine the construct validity of the survey instrument and to assess distinct factors associated with GDDP utilization. Descriptive statistics were used to summarize the distribution of patient socio-demographic characteristics and questionnaire responses. Multivariate logistic regression was used to compute adjusted odds ratios and to examine the strength of association with GDDP utilization after adjusting for participant socio-demographic features that were statistically significant at a priori level of P < 0.05. RESULTS In this study, 72% of respondents were aware of the GDDP, and 61% had utilized the GDDP. Participants were 4 times likely to use a GDDP when their physician (AOR: 4.0, 95% CI: 2.6-6.4, P < 0.001) or pharmacist (AOR: 4.0, 95% CI: 2.6-6.3, P < 0.001) talked to them about it. Participants indicated that the most important barriers to utilization of GDDPs were lack of awareness (44%), and lack of recommendation by a physician (19%). CONCLUSIONS Increased patient awareness and physician recommendation may increase the use of GDDPs, which may lead to improved compliance with medications, better health outcomes and reduced health care costs.
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Affiliation(s)
- Anthony Omojasola
- The Dorothy I. Height - Center for Health Equity & Evaluation Research, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
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15
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Galbraith AA, Sinaiko AD, Soumerai SB, Ross-Degnan D, Dutta-Linn MM, Lieu TA. Some families who purchased health coverage through the Massachusetts Connector wound up with high financial burdens. Health Aff (Millwood) 2013; 32:974-83. [PMID: 23595500 DOI: 10.1377/hlthaff.2012.0864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health insurance exchanges created under the Affordable Care Act will offer coverage to people who lack employer-sponsored insurance or have incomes too high to qualify for Medicaid. However, plans offered through an exchange may include high levels of cost sharing. We surveyed families participating in unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority, an exchange created prior to the 2010 national health reform law, and found high levels of financial burden and higher-than-expected costs among some enrollees. The financial burden and unexpected costs were even more pronounced for families with greater numbers of children and for families with incomes below 400 percent of the federal poverty level. We conclude that those with lower incomes, increased health care needs, and more children will be at particular risk after they obtain coverage through exchanges in 2014. Policy makers should develop strategies to further mitigate the financial burden for enrollees who are most susceptible to encountering higher-than-expected out-of-pocket costs, such as providing cost calculators or price transparency tools.
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Affiliation(s)
- Alison A Galbraith
- Department of Population Medicine at Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
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16
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Guessous I, Gaspoz JM, Theler JM, Wolff H. High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage. Prev Med 2012; 55:521-7. [PMID: 22940614 DOI: 10.1016/j.ypmed.2012.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/18/2012] [Accepted: 08/16/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland. METHOD Population-based survey (2007-2010) of a representative sample aged 35-74 years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. RESULTS A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income ≥ 13,000 CHF (1CHF ≈ 1$) to 30.9% in the group with a monthly income <3000 CHF. In subjects with a monthly income <3000 CHF, the percentage who had forgone healthcare increased from 22.5% in 2007/8 to 34.7% in 2010 (P trend=0.2). Forgoing healthcare for economic reasons was associated with lower income, female gender, smoking status, lower job position, having dependent children, being divorced and single, paying a higher deductible, and receiving a premium subsidy. CONCLUSION In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.
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Affiliation(s)
- I Guessous
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Switzerland.
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17
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Martin KR, Shreffler J, Schoster B, Callahan LF. Coping with prescription medication costs: a cross-sectional look at strategies used and associations with the physical and psychosocial health of individuals with arthritis. Ann Behav Med 2012; 44:236-47. [PMID: 22740363 PMCID: PMC3443256 DOI: 10.1007/s12160-012-9380-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ. PURPOSE The purposes of this study are (1) to identify characteristics of individuals with arthritis who self-report prescription medication cost-coping strategies and (2) to examine the association between medication cost-coping strategies and health status. METHODS Seven hundred twenty-nine people self-reporting arthritis and prescription medication use completed a telephone survey. Adjusted regression models examined medication cost-coping strategies and five health status outcomes. RESULTS Participants reported engaging in cost-coping strategies due to medication costs. Those borrowing money had worse psychosocial health and greater disability; those with increasing credit card debt reported worse physical functioning, self-rated health, and greater helplessness. Medication underuse was associated with worse psychosocial health, greater disability, and depressive symptoms. CONCLUSION Individuals with arthritis use multiple strategies to cope with medication costs, and these strategies are associated with adverse physical and psychosocial health status.
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Affiliation(s)
- Kathryn Remmes Martin
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD 20892-9205, USA.
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18
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Tarn DM, Mattimore TJ, Bell DS, Kravitz RL, Wenger NS. Provider views about responsibility for medication adherence and content of physician-older patient discussions. J Am Geriatr Soc 2012; 60:1019-26. [PMID: 22646818 DOI: 10.1111/j.1532-5415.2012.03969.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate provider opinions about responsibility for medication adherence and examine physician-patient interactions to illustrate how adherence discussions are initiated. DESIGN Focus group discussions with healthcare providers and audio taped outpatient office visits with a separate group of providers. SETTING Focus group participants were recruited from multispecialty practice groups in New Jersey and Washington, District of Columbia. Outpatient office visits were conducted in primary care offices in Northern California. PARTICIPANTS Twenty-two healthcare providers participated in focus group discussions. One hundred patients aged 65 and older and 28 primary care physicians had their visits audio taped. MEASUREMENTS Inductive content analysis of focus groups and audio taped encounters. RESULTS Focus group analyses indicated that providers feel responsible for assessing medication adherence during office visits and for addressing mutable factors underlying nonadherence, but they also believed that patients were ultimately responsible for taking medications and voiced reluctance about confronting patients about nonadherence. The 100 patients participating in audio taped encounters were taking a total of 410 medications. Of these, 254 (62%) were discussed in a way that might address adherence; physicians made simple inquiries about current patient medication use for 31.5%, but they made in-depth inquiries about adherence for only 4.3%. Of 39 identified instances of nonadherence, patients spontaneously disclosed 51%. CONCLUSION The lack of intrusive questions about medication taking during office visits may reflect poor provider recognition of the questions needed to assess adherence fully. Alternatively, provider beliefs about patient responsibility for adherence may hinder detailed queries. A paradigm of joint provider-patient responsibility may be needed to better guide discussions about medication adherence.
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Affiliation(s)
- Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, USA.
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Comis RL, Miller JD, Colaizzi DD, Kimmel LG. Physician-related factors involved in patient decisions to enroll onto cancer clinical trials. J Oncol Pract 2011; 5:50-6. [PMID: 20856718 DOI: 10.1200/jop.0922001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The development of new cancer therapies requires additional, and more complex, clinical trials. But only approximately 3% to 5% of adult cancer patients participate in cancer clinical trials. This study seeks to identify and understand the attitudes of the public and cancer survivors toward health-related decisions and cancer clinical trials to identify the key factors that must be addressed to increase that percentage.
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Affiliation(s)
- Robert L Comis
- Coalition of Cancer Cooperative Groups, Philadelphia, PA; and Michigan State University, East Lansing, MI
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20
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Mathews M, Buehler S, West R. Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care. ACTA ACUST UNITED AC 2011; 16:3-8. [PMID: 19672419 PMCID: PMC2722056 DOI: 10.3747/co.v16i4.375] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective We aimed to describe the perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care. Methods We conducted semi-structured interviews with 21 cancer care providers (nurses, social workers, oncologists, surgeons, pharmacists, and dieticians) in Newfoundland and Labrador. Results Patients try to minimize costs by substituting or rationing medications, choosing radical treatments, lengthening the time between follow-up appointments, choosing inpatient care, and working during treatment to minimize loss of income. Providers respond to the financial concerns of patients by helping them to access financial assistance programs, by changing chemotherapy and supportive drug prescriptions, and by shortening radiation treatment protocols. They admit patients to hospital and arrange follow-up with physicians closer to a patient’s home. Conclusions Out-of-pocket costs resulting from cancer care are incurred at all phases of treatment and follow-up. These costs are substantial concerns for some patients and their health care providers. Encouraging communication between patients and their providers is needed to identify individuals at risk and to safely modify care plans. Tele-oncology and public drug, medical travel, and leave programs are needed to ensure that patients are better able to afford the costs related to cancer care.
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Affiliation(s)
- M Mathews
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL.
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21
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Miller JD, Kotowski MR, Comis RL, Smith SW, Silk KJ, Colaizzi DD, Kimmel LG. Measuring cancer clinical trial understanding. HEALTH COMMUNICATION 2011; 26:82-93. [PMID: 21218302 DOI: 10.1080/10410236.2011.527624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Researchers, practitioners, and participants in cancer clinical trials must have a clear understanding of clinical trials if participation in them is to be solicited ethically and effectively. A valid and reliable measure of cancer clinical trial understanding did not exist prior to a 2005 study conducted for the Coalition of Cooperative Cancer Groups. This report outlines a measure derived from that study, discusses the rationale for its component items, examines its psychometric properties, and demonstrates the relationship of this measure to the enrollment decision. Data from national samples of cancer survivors and the general public demonstrate the measure's validity and reliability. Results are discussed as they relate to patient understanding of clinical trials, informed decision making, and health communication processes.
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Affiliation(s)
- Jon D Miller
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48823, USA.
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Schmittdiel JA, Steers N, Duru OK, Ettner SL, Brown AF, Fung V, Hsu J, Quiter E, Tseng CW, Mangione CM. Patient-provider communication regarding drug costs in Medicare Part D beneficiaries with diabetes: a TRIAD Study. BMC Health Serv Res 2010; 10:164. [PMID: 20546616 PMCID: PMC2893177 DOI: 10.1186/1472-6963-10-164] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about drug cost communications of Medicare Part D beneficiaries with chronic conditions such as diabetes. The purpose of this study is to assess Medicare Part D beneficiaries with diabetes' levels of communication with physicians regarding prescription drug costs; the perceived importance of these communications; levels of prescription drug switching due to cost; and self-reported cost-related medication non-adherence. METHODS Data were obtained from a cross-sectional survey (58% response rate) of 1,458 Medicare beneficiaries with diabetes who entered the coverage gap in 2006; adjusted percentages of patients with communication issues were obtained from multivariate regression analyses adjusting for patient demographics and clinical characteristics. RESULTS Fewer than half of patients reported discussing the cost of medications with their physicians, while over 75% reported that such communications were important. Forty-eight percent reported their physician had switched to a less expensive medication due to costs. Minorities, females, and older adults had significantly lower levels of communication with their physicians regarding drug costs than white, male, and younger patients respectively. Patients with < $25 K annual household income were more likely than higher income patients to have talked about prescription drug costs with doctors, and to report cost-related non-adherence (27% vs. 17%, p < .001). CONCLUSIONS Medicare Part D beneficiaries with diabetes who entered the coverage gap have low levels of communication with physicians about drug costs, despite the high perceived importance of such communication. Understanding patient and plan-level characteristics differences in communication and use of cost-cutting strategies can inform interventions to help patients manage prescription drug costs.
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Abstract
BACKGROUND The literature on nonfulfillment of prescription medications spans over three decades of work. There is a wide variation in reported nonfulfillment rates, but no previous study has systematically reviewed this literature to explore the reasons behind this variation. OBJECTIVE The objective of this study was to review estimates of medication nonfulfillment rates and published reasons for nonfulfillment and explore whether nonfulfillment rates vary by study variables. METHODS Articles were identified through searches conducted on MEDLINE, CINAHL, Psych Info, and EMBASE, and review of relevant reference citations. Methodological variables, nonfulfillment rate, and unit of analysis (i.e., patient or prescription) were abstracted from each article selected for review. Mean and median nonfulfillment rates for groups categorized by unit of analysis and selected methodological variables (method for assessing nonfulfillment, sample characteristics, disease subgroup, sample size, country of data collection, recall period or time allowed before classifying as nonfulfillment, and year of study) were calculated. Reasons for nonfulfillment were abstracted from all articles that included a relevant discussion. FINDINGS A total of 79 studies reporting pure nonfulfillment rates (59 at the patient level and 20 at the prescription level) and six studies reporting nonfulfillment rates in combination with nonpersistence rates were included. There was a wide variation in nonfulfillment rates reported by the studies - from 0.5% to 57.1%. The three primary reasons for nonfulfillment identified from this review were perceived concerns about medications, lack of perceived need for medications, and medication affordability issues. CONCLUSION To the best of the authors' knowledge, this study is the first narrative systematic review on nonfulfillment of prescription medications. Despite the wide variation in individual study rates, the mean and median rates across different modes of data collection and sources of data were in a relatively narrow range (11% to 19%) and surprisingly close to the overall mean (16.4%) and median (15%.0) rates for all studies. The reasons for nonfulfillment identified through this review address barriers to nonfulfillment at the patient, physician, and health system level and thus bear important implications for policy makers.
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Craig BM, Strassels SA. Out-of-pocket prices of opioid analgesics in the United States, 1999-2004. PAIN MEDICINE (MALDEN, MASS.) 2010; 11:240-7. [PMID: 20002589 PMCID: PMC3811926 DOI: 10.1111/j.1526-4637.2009.00762.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the out-of-pocket prices of common opioid analgesics by medication, drug coverage, region, and year. DESIGN Retrospective cohort study using 1999-2004 data from the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. SETTING U.S. civilian noninstitutionalized population. PATIENTS Adults not enrolled in Medicaid who filled prescriptions for opioid analgesics between 1999 and 2004. OUTCOME MEASURES Prices of prescribed analgesics were collected from receipts, medication containers, patient recall, and administrative records (N = 20,926 and 31,500, respectively). RESULTS Average out-of-pocket price of an opioid analgesic prescription was around $10, but the estimate is potentially misleading: A typical adult patient without drug coverage paid $12.86-$61.60 to fill his or her analgesic prescription, depending on medication. The extended-release formulations cost more than double the immediate release prices. For the analgesics studied, drug coverage lowered out-of-pocket prices by 50-85%, while market prices increased at a rate of 5.7-9% per year with little regional variation. Data did not include prices for medications not prescribed or prescribed, but not acquired. CONCLUSIONS Independent of the diagnosis, patients' out-of-pocket price for prescribed analgesics fluctuated freely in the United States across time, region, and coverage status. These fluctuations potentially distort the delivery of effective pain management and further burden an already afflicted population.
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Affiliation(s)
- Benjamin M Craig
- Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, Florida 33612-9416, USA.
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Litwin H, Sapir EV. Forgone health care due to cost among older adults in European countries and in Israel. Eur J Ageing 2009; 6:167-176. [PMID: 23293574 DOI: 10.1007/s10433-009-0126-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study sought to identify the principal factors that predict forgone health care due to cost among European and Israeli older adults. The analysis applied the Andersen-Newman model of health service utilization to data from the first wave of the Survey of Health, Ageing and Retirement in Europe (n = 28,849). Relinquished health care was regressed on the predisposing characteristics, need factors and economic access attributes of the respondents, in general, and in each of 12 countries, in particular. The results showed that forgone health care due to cost occurs among a substantial minority of older adults. Moreover, relinquished care is associated with younger old age, greater health needs and perceived economic inadequacy. Although statistically significant in certain cases, country of residence does not constitute a robust predictor of health care relinquishment. Social policy should address the antecedents of forgone health care in order to more effectively meet the health needs of the older population.
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Affiliation(s)
- Howard Litwin
- Israel Gerontological Data Center, Hebrew University, Jerusalem, Israel
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Resident physician and hospital pharmacist familiarity with patient discharge medication costs. ACTA ACUST UNITED AC 2009; 31:195-201. [DOI: 10.1007/s11096-009-9280-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 12/28/2008] [Indexed: 11/27/2022]
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Cobaugh DJ, Angner E, Kiefe CI, Ray MN, LaCivita CL, Weissman NW, Saag KG, Allison JJ. Effect of racial differences on ability to afford prescription medications. Am J Health Syst Pharm 2008; 65:2137-43. [DOI: 10.2146/ajhp080062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Daniel J. Cobaugh
- American Society of Health-System Pharmacists (ASHP) Research and Education Foundation, Bethesda, MD
| | - Erik Angner
- Departments of Philosophy and Finance, University of Alabama at Birmingham (UAB), Birmingham
| | - Catarina I. Kiefe
- Division of Preventive Medicine, School of Medicine, and Founding Director, Center for Outcomes and Effectiveness Research and Education, UAB
| | - Midge N. Ray
- Department of Health Services Administration, School of Health Professions, and Associate Professor, Center for Education and Research on Therapeutics of Musculoskeletal Diseases, UAB
| | | | - Norman W. Weissman
- Department of Health Services Administration, School of Health Professions, UAB
| | - Kenneth G. Saag
- Center for Education and Research on Therapeutics of Musculoskeletal Diseases, and Professor of Medicine, School of Medicine, UAB
| | - Jeroan J. Allison
- Center for Education and Research on Therapeutics of Musculoskeletal Diseases, and Professor of Medicine, School of Medicine, UAB
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Wilbur K. Hospital Pharmacist Familiarity with Patient Discharge Medication Costs. J Pharm Technol 2008. [DOI: 10.1177/875512250802400503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Drug therapy poses a financial burden for many individuals. Cost-related medication nonadherence is ultimately associated with increased healthcare resource utilization and poor patient outcomes. Physicians are often unaware of the costs associated with their prescribed therapy, but little is documented regarding familiarity of hospital pharmacists with out-of-pocket medication expenses borne by patients in the community setting. Objective: To evaluate how familiar hospital pharmacists are with prescribed medication costs for discharged patients. Methods: Hospital pharmacists within a specific healthcare organization were invited to participate in an online survey. Ten brief patient case scenarios and associated discharge therapeutic regimens were outlined and respondents were asked to identify the costs that discharged patients would incur when having the prescriptions filled. The total number and proportion of estimates either above or below the actual medication cost as determined from community pharmacies were calculated. Results: Thirty-one pharmacists completed the survey. For the therapeutic regimens described, 47% of medication costs were underestimated, 33% were overestimated, and 20% were correctly estimated (within 10% of the actual value). Incorrect estimates were evident across all therapeutic classes and medical indications presented in the survey. The greatest mean absolute cost differences were underestimation of a linezolid treatment course for skin and soft tissue infection ($384.18 below the mean absolute cost) and overestimation of monthly bisoprolol heart failure therapy ($22.42). Conclusions: Hospital pharmacists are often unfamiliar with what discharged patients must pay for drug therapy.
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Affiliation(s)
- Kerry Wilbur
- KERRY WILBUR BScPharm ACPR PharmD, Assistant Professor, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar, fax 974/493-0449
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Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS. Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis. Med Care 2007; 45:891-5. [PMID: 17712260 DOI: 10.1097/mlr.0b013e318074ce9b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). METHODS The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health. RESULTS After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale. CONCLUSIONS We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.
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Affiliation(s)
- Stephen Joel Coons
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA.
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Tseng CW, Dudley RA, Brook RH, Keeler E, Steers WN, Alexander GC, Waitzfelder BE, Mangione CM. Elderly patients' preferences and experiences with providers in managing their drug costs. J Am Geriatr Soc 2007; 55:1974-80. [PMID: 17944892 DOI: 10.1111/j.1532-5415.2007.01445.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether elderly patients with high drug expenditures want and receive providers' help in managing drug costs. DESIGN Cross-sectional survey. SETTING A Medicare managed care plan (>400,000 members) in one state in 2002. PARTICIPANTS One thousand one hundred six seniors (62% response rate) sampled so that half exceeded caps on their drug benefits the previous year, and all had total drug expenditures in the top quartile of members in their cap level. MEASUREMENTS Participants' preferences and experiences with providers discussing costs and participation in choosing medications. RESULTS Two-thirds reported difficulty paying for medications, and one-fourth decreased medication use because of cost. Most wanted providers to ask about medication affordability (81%), consider cost (86%), offer choices (70%), and to persuade them or decide for them which medication to use (88%), but few said providers asked about affordability (17%), usually or always discussed prices (19%), or offered choices (45%), although nearly all said providers chose their medications (93%). Sixty-two percent had asked providers for help with drug costs, although 34% who used less medication because of cost or had difficulty paying for medications had not asked for help. CONCLUSION Providers should be aware that elderly patients want their help in managing drug costs but do not always receive it or ask for help when they need it. Providers could improve communication by initiating conversations about cost and by asking patients about preferences when prescribing.
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Affiliation(s)
- Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii, Honolulu, Hawaii, USA.
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Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med 2007; 22:864-71. [PMID: 17410403 PMCID: PMC2219866 DOI: 10.1007/s11606-007-0180-x] [Citation(s) in RCA: 258] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 01/05/2007] [Accepted: 03/06/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs. DESIGN We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies. Articles were selected if the study included an explicit measure of CRN and reported results on covarying characteristics. MAIN RESULTS We found 19 studies with empirical support for concluding that certain patients may be susceptible to CRN: research has established consistent links between medication nonadherence due to costs and financial burden, but also to symptoms of depression and heavy disease burden. Only a handful of studies with limited statistical methods provided evidence on whether patients understand the health risks of CRN or to what extent clinicians influence patients to keep taking medications when faced with cost pressures. No relationship emerged between CRN and polypharmacy. CONCLUSION Efforts to reduce cost-related medication nonadherence would benefit from greater study of factors besides the presence of prescription drug coverage. Older patients with chronic diseases and mood disorders are at-risk for CRN even if enrolled in Medicare's new drug benefit.
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Affiliation(s)
- Becky A Briesacher
- Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605, USA.
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Beran MS, Laouri M, Suttorp M, Brook R. Medication costs: the role physicians play with their senior patients. J Am Geriatr Soc 2007; 55:102-7. [PMID: 17233692 DOI: 10.1111/j.1532-5415.2006.01011.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine how often primary care physicians discuss medication costs with their senior patients and what cost-reducing strategies they employ. DESIGN Cross-sectional, random-sample mail questionnaire. SETTING State of California. PARTICIPANTS Six hundred seventy-eight of 1,098 (62%) internal medicine and family practice physicians selected from the American Medical Association Masterfile. MEASUREMENTS Main outcomes included frequency of cost discussions with senior patients in the previous 30 days and choice of cost-reducing strategy when a senior expresses financial difficulty with medication costs. RESULTS Forty-three percent of physicians reported discussing medication cost with at least half of their senior patients in the previous 30 days. Patients initiated most of these discussions. Forty percent reported that, at least one time in the previous 30 days, they had not discussed cost but wished they had. The most common reason given was "I ran out of time" (36%). Physicians with high perceived knowledge of medication costs were more likely to discuss cost (odds ratio (OR)=3.49, 95% confidence interval (CI)=1.66-7.3) versus low perceived knowledge, but this trend was not seen in physicians who scored high on actual knowledge of medication costs (OR=0.78, 95% CI=0.43-1.43) versus low actual knowledge. The most common cost-reducing strategies were generic substitution (33%) and offering samples (25%). CONCLUSION The frequency of medication cost discussions between physicians and senior patients is low, and when it occurs, is often initiated by patients. Physicians' perception of their knowledge of medication costs may be an important factor in initiating cost discussions.
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Affiliation(s)
- Mary Sue Beran
- Park Nicollet Institute, Health Research Center, Minneapolis, MN 55416, USA.
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Federman AD, Alexander GC, Shrank WH. A practical physicians' guide to the Medicare drug benefit plan. Mayo Clin Proc 2006; 81:1217-21. [PMID: 16970218 DOI: 10.4065/81.9.1217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent commentaries on Medicare Part D highlight both the early failings and the successes of the program. However, regardless of one's opinions about the program, Part D is a reality that millions of Medicare beneficiaries must address now and in the future. The ultimate economic, policy, and clinical success of the Medicare drug benefit plan depends on its transparency and ability to be navigated together by patients, physicians, and other parties. Although Medicare Part D is likely to evolve considerably in the future, it will continue to present elderly adults with numerous plan options and rules and therefore present persistent challenges for patients and physicians. By focusing on a few crucial aspects of Part D and taking advantage of available resources, physicians can simplify Part D for their patients, help them make informed decisions about enrollment and plan selection, and possibly help them save money with their current PDP. This may, in turn, reduce beneficiaries' out-of-pocket prescription costs, thereby improving patients' access to medications and possibly their medication adherence and health outcomes as well.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, Mount Sinai Hospital, New York, New York 10029, USA.
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Piette JD, Heisler M, Wagner TH. Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures. J Clin Epidemiol 2006; 59:739-46. [PMID: 16765278 DOI: 10.1016/j.jclinepi.2005.11.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 10/29/2005] [Accepted: 11/14/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Little is known about how patients facing medication cost pressures make choices about whether to underuse one or more of their prescription drugs. We calculated the probability that older adults would underuse prescription medications for common chronic illnesses because of cost concerns. We also identified differences in cost-related underuse between symptom-relief medications (e.g., analgesics) and primarily "preventive" medications (e.g., antihypertensives). MATERIALS AND METHODS Older chronically ill patients using both symptom-relief and preventive medications (N = 2,008) were identified as part of a nationwide survey in the United States and reported information about their cost-related underuse of 16 medication types. We used regression models to estimate the probability of underuse for each medication type, assuming average out-of-pocket costs, no prescription coverage, and the sociodemographic characteristics of a typical American aged 50+. RESULTS 23% of respondents reported forgoing medication in the prior year due to cost. The likelihood of cost-related underuse was higher for symptom-relief medications (27%) than for primarily preventive medications (20%, P < .001). Among the subset of patients who cut back on adherence due to cost, the likelihood of forgoing symptom-relief medication (69%) was higher than that for preventive drugs (54%, P < .001). CONCLUSIONS Medication characteristics beyond cost alone influence decisions to underuse treatment in response to financial pressures.
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Affiliation(s)
- John D Piette
- Department of Veterans Affairs Center for Practice Management and Outcomes Research, University of Michigan, Ann Arbor, MI 48113-0170, USA.
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Patel UD, Davis MM. Falling into the Doughnut Hole: Drug Spending among Beneficiaries with End-Stage Renal Disease under Medicare Part D Plans. J Am Soc Nephrol 2006; 17:2546-53. [PMID: 16855016 DOI: 10.1681/asn.2005121385] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The Medicare Part D prescription drug benefit may facilitate provision of medications by subsidizing drug costs. However, beneficiaries with higher drug utilization may face higher out-of-pocket (OOP) costs under the benefit's "doughnut hole" provisions that substantially increase beneficiary cost-sharing. The Medicare Current Beneficiary Survey Cost and Use data for 1997 through 2001 were used to estimate the impact of the standard Part D benefit on drug expenditures. The sample consisted of adults who were not dually enrolled in Medicaid (41,617 without ESRD, 256 with ESRD). Outcomes were annual total and OOP drug spending projected to 2006, as well as estimates of individual spending changes under Part D. In 2006, ESRD beneficiaries will have mean annual total and OOP expenditures that are approximately twice that of their Medicare peers. The overall impact of Part D on OOP expenditures is similar among all beneficiaries; however, many individuals with employer-sponsored coverage and those with higher costs (especially those with ESRD) may face cost increases with significant monthly variability as a result of reaching the "doughnut hole," a no-coverage gap in the standard benefit. Therefore, ESRD beneficiaries face substantial total and OOP annual expenditures for medications, causing most to reach the Part D benefit gap. Higher OOP costs may lead to reductions in spending and medication use with subsequent treatment gaps that may lead to increased use of medical services. As the new legislation takes effect, policy makers who are considering modifications in the program may benefit from further research to monitor patterns and gaps in coverage, medication use and spending, and hospitalization and survival trends.
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Affiliation(s)
- Uptal D Patel
- Duke University Medical Center, Box 3646, Division of Nephrology, Durham, NC 27710, USA.
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Kronish IM, Federman AD, Morrison RS, Boal J. Medication utilization in an urban homebound population. J Gerontol A Biol Sci Med Sci 2006; 61:411-5. [PMID: 16611710 DOI: 10.1093/gerona/61.4.411] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The number of medically homebound adults has grown with the aging of the U.S. population, yet little is known about their health care utilization. We sought to characterize the health status and medication utilization of an urban cohort of homebound adults and to identify factors associated with medication use in this population. METHODS We performed a retrospective cross-sectional analysis of 415 patients enrolled in a primary care program for homebound adults in New York City during October 2002. Numbers of medications were obtained from formularies corroborated by home visits. For patients without prescription insurance, medication out-of-pocket costs were estimated according to average wholesale pricing. Sociodemographic and disease characteristics were obtained by chart abstraction. RESULTS The median age was 83 years (range 25-106 years). Seventy-seven percent of patients were female, 63% were non-white, and 28% spoke Spanish. Sixty-four percent of patients had Medicaid. The cohort had a mean of 8.2 (range 1-27, standard deviation 4.5) medications prescribed per month. Multivariate analysis showed that increasing age was associated with fewer medications (p <.001). Charlson comorbidity score was positively associated with number of medications (p <.001), whereas Activities of Daily Living score, a measure of functional dependence, was not. Twenty-seven percent of the cohort lacked prescription drug coverage. The total number of medications per month among the uninsured patients was 7.4 (standard deviation 4.4). Estimated median monthly out-of-pocket cost for the uninsured patients was dollar 223 (range dollar 1-dollar 1512). CONCLUSIONS For homebound patients without prescription drug coverage, medication use may represent substantial financial burden. Additional research is needed to determine whether out-of-pocket medication costs represent a barrier to care in this population.
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Affiliation(s)
- Ian M Kronish
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Piette JD, Heisler M. The Relationship Between Older Adults' Knowledge of Their Drug Coverage and Medication Cost Problems. J Am Geriatr Soc 2006; 54:91-6. [PMID: 16420203 DOI: 10.1111/j.1532-5415.2005.00527.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether chronically ill patients have gaps in knowledge about their prescription drug coverage and establish the relationship between gaps and medication cost problems. DESIGN Nationwide, cross-sectional survey. SETTING Nationwide survey conducted via the Internet. PARTICIPANTS Three thousand one hundred nineteen adults aged 50 and older (1,400 of whom were aged > or = 65) who had prescription drug coverage and at least one chronic illness. MEASUREMENTS Patients were asked about features of their drug benefits and whether they had experienced problems due to medication costs in the prior year. RESULTS Twenty-five percent of respondents reported not knowing their usual prescription copayments, and 41% did not know whether there were caps on their drug coverage. Nonwhite race and lower income were independent risk factors for lack of knowledge about these aspects of pharmacy benefits. Lack of knowledge regarding the limits of coverage was associated with a greater likelihood of cutting back on medication use because of cost pressures, forgoing basic needs because of medication costs, borrowing money to pay for prescriptions, and worrying about medication costs (all P<.05). CONCLUSION Many older adults with prescription drug coverage do not know important features of their pharmacy benefits. Racial minorities and those with low incomes may have the greatest difficulty understanding coverage and as a result may be at greatest risk for underusing their benefits. Education about Medicare reforms and other efforts to increase prescription coverage should accompany these policies.
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Affiliation(s)
- John D Piette
- Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48113, USA.
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Piette JD, Heisler M, Horne R, Caleb Alexander G. A conceptually based approach to understanding chronically ill patients' responses to medication cost pressures. Soc Sci Med 2005; 62:846-57. [PMID: 16095789 DOI: 10.1016/j.socscimed.2005.06.045] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Indexed: 11/18/2022]
Abstract
Prescription medications enhance the well-being of most chronically ill patients. Many individuals, however, struggle with how to pay for their treatments and as a result experience problems with self-care and health maintenance. Although studies have documented that high out-of-pocket costs are associated with medication non-adherence, little research on prescription cost sharing has been theoretically grounded in knowledge of the more general determinants of patients' self-management behaviors and chronic disease outcomes. We present a conceptual framework for understanding the influence of patient, medication, clinician, and health system factors on individuals' responses to medication costs. We review what is known about how these factors influence medication adherence, identify possible strategies through which clinicians, health systems, and policy-makers may assist patients burdened by their medication costs, and highlight areas in need of further research. Although medication costs represent a burden to chronically ill patients worldwide, most patients report using their medication as prescribed despite the costs, and others report cost-related underuse despite an apparent ability to afford those treatments. The cost-adherence relationship is modified by contextual factors, including patients' characteristics (e.g., age, ethnicity, and attitudes toward medications), the type of medications they are using (e.g., the complexity of dosing and the drug's clinical target), clinician factors (e.g., choice of first-line agent and communication about medication costs), and health system factors (e.g., efforts to influence clinicians' prescribing and to help patients apply for financial assistance programs). Understanding these relationships will enable clinicians and policy-makers to better design pharmacy benefits and assist patients in taking their medication as prescribed. The next generation of studies examining the consequences of prescription drug costs should expand our knowledge of the ways in which these co-factors influence patients' responses to medication cost pressures.
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Affiliation(s)
- John D Piette
- VA Healthcare System and University of Michigan, Ann Arbor, MI, USA.
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Affiliation(s)
- Michele Heisler
- Ann Arbor VA Center for Practice Management and Outcomes Research and the Division of General Medicine, University of Michigan Health System, Ann Arbor 48113, USA.
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