Alexander G Caleb, Casalino Lawrence P, Meltzer David O
Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, Ill 60637, USA.
JAMA. 2003 Aug 20;290(7):953-8. doi: 10.1001/jama.290.7.953.
Out-of-pocket costs account for approximately one fifth of health care expenditures and are increasing. Previous research suggests that these costs are associated with medication nonadherence and considerable economic burden among some patients. Little is known about patient-physician communication regarding these costs.
To identify patients' and physicians' beliefs and practices regarding discussions of out-of-pocket costs.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional paired surveys of 133 general internists and 484 of their outpatients, aged 18 years or older, in 3 academic and 18 community general medicine practices in the Chicago metropolitan area, March-November 2002.
Patient and physician beliefs regarding discussions of out-of-pocket costs, frequency and predictors of discussions, and physician recognition of patient burden from out-of-pocket costs.
Sixty-three percent of patients reported a desire to talk with their physician about their out-of-pocket costs, and 79% of physicians believed that patients in general want to discuss these costs. By contrast, only 35% of physicians and 15% of patients reported ever having discussed the study patient's out-of-pocket costs. Multivariate analysis indicated that discussions were significantly more likely to occur with patients burdened by their out-of-pocket costs (prevalence ratio [PR], 2.55; 95% confidence intervals [CI], 1.62-3.76) and with those patients seen in a community practice (PR, 5.19; CI, 1.86-8.93). Among patients burdened by out-of-pocket costs, physicians were substantially more likely to recognize this burden when a prior discussion regarding out-of-pocket costs had taken place (80% vs 51%).
Among respondents, both patients and physicians believed that discussions of out-of-pocket costs were important, yet these discussions occurred infrequently. Physician communication with patients about out-of-pocket costs may be an important yet neglected aspect of current clinical practice. Further research should identify the prevalence of this problem in broader populations, investigate its causes, and evaluate the impact of enhanced communication about out-of-pocket costs on patient satisfaction, utilization of care, and outcomes.
自付费用约占医疗保健支出的五分之一，且呈上升趋势。先前的研究表明，这些费用与用药依从性差以及部分患者的沉重经济负担有关。对于医患之间关于这些费用的沟通情况，人们了解甚少。
确定患者和医生对于讨论自付费用的看法和做法。
设计、地点和参与者：2002年3月至11月，对芝加哥大都市地区3家学术机构和18家社区普通内科诊所的133名普通内科医生及其484名18岁及以上门诊患者进行横断面配对调查。
患者和医生对讨论自付费用的看法、讨论的频率和预测因素，以及医生对患者自付费用负担的认知。
63%的患者表示希望与医生谈论自付费用，79%的医生认为一般患者都想讨论这些费用。相比之下，只有35%的医生和15%的患者报告曾讨论过研究患者的自付费用。多变量分析表明，与自付费用负担沉重的患者（患病率比[PR]，2.55；95%置信区间[CI]，1.62 - 3.76）以及在社区诊所就诊的患者（PR，5.19；CI，1.86 - 8.93）进行讨论的可能性显著更高。在自付费用负担沉重的患者中，如果之前曾就自付费用进行过讨论，医生更有可能认识到这种负担（80%对51%）。
在受访者中，患者和医生都认为讨论自付费用很重要，但此类讨论很少发生。医生与患者就自付费用进行沟通可能是当前临床实践中一个重要但被忽视的方面。进一步的研究应确定该问题在更广泛人群中的患病率，调查其原因，并评估加强关于自付费用的沟通对患者满意度、医疗服务利用和治疗结果的影响。
