Cost as a Feature of Medication Management Communication in Medical Visits Public Deposited

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  • March 20, 2019
  • Beard, Ashley J.
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
  • Little is known about how patients and physicians discuss medication costs in medical visits, if such discussions impact decision making, and if patients are more satisfied with their medications if they discuss cost. The predominance of medication therapy, the need for continuous treatment, and the variation in medication costs make it especially important to examine the extent to which rheumatoid arthritis (RA) patients discuss issues related to medication costs, how they manage their medications with their physicians, and how this relates to patient-reported medication satisfaction. This is a cross-sectional secondary analysis of survey and clinic visit audiotape data that were collected in North Carolina from 2003 to 2005 from 8 rheumatologists and 200 of their adult patients with RA. Qualitative analyses were conducted to examine the content of communication about medication costs and management in routine rheumatology clinic visits. Quantitative analyses employing multivariable models were conducted to examine the influence of patient, physician, and medication characteristics on visit communication about medication costs, management, and satisfaction. Results revealed that 34% of medical visits contained medication cost communication and the content centered on insurance coverage and strategies to reduce patient out-of-pocket medication expenses. Quantitative results revealed that patients identifying as White/Caucasian and those with no prescription drug coverage were significantly more likely to discuss medication costs. Results revealed that medication cost communication and disclosure of patient-initiated regimen changes were significantly, positively associated with one another. In over 20% of visits, patients disclosed self-initiated changes to their medication regimens and the communication demonstrated that patients were active managers of their medications. Patients disclosed taking more, less, and substituting medications for those prescribed. Almost unanimously, the regimen changes reduced their total RA medication cost burden. However, neither communication about medication costs nor patient medication management significantly predicted medication regimen changes in the medical visit and no factors reliably predicted patient-reported medication satisfaction. These findings have implications for conceptualizing medical visit communication about medication costs and management. Better understanding of these topics provides guidance for the development of conceptual frameworks and interventions to improve communication, and thereby improve care.
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  • In Copyright
  • Sleath, Betsy
  • Open access

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