Piette John D, Heisler Michele, Wagner Todd H
Department of Veterans Affairs Center for Practice Management and Outcomes Research, University of Michigan, Ann Arbor 48113-0170, USA.
Arch Intern Med. 2004 Sep 13;164(16):1749-55. doi: 10.1001/archinte.164.16.1749.
Although many chronically ill patients underuse prescription medications because of cost concerns, we know little about their discussions with clinicians about this issue.
Nationwide survey of 660 older adults with chronic illnesses who reported underusing medication in the prior year because of cost. We assessed whether patients discussed cost-related medication underuse with clinicians, reasons that some patients did not talk with clinicians about this problem, how clinicians responded when this issue was raised, and how helpful patients perceived clinicians to be.
Two thirds of respondents never told a clinician in advance that they planned to underuse medication because of the cost, and 35% never discussed the issue at all. Of those who did not tell a clinician, 66% reported that nobody asked them about their ability to pay for prescriptions and 58% reported that they did not think providers could help them. When patients talked with clinicians about medication costs, 72% found those conversations helpful. However, 31% reported that their medications were never changed to a generic or less expensive alternative, and few patients were given other forms of assistance such as information about programs that help pay drug costs (30%) or where to purchase less expensive medication (28%). Patients were most likely to find clinicians helpful if clinicians provided free samples, asked about problems paying for prescriptions, and offered advice about how to pay for patients' current regimens.
About one third of chronically ill adults who underuse prescription medication because of the cost never talk with clinicians in advance, and many never raise this issue at all. Clinicians should take a more proactive role in identifying and assisting patients who have problems paying for prescription drugs.
尽管许多慢性病患者因费用问题未充分使用处方药，但我们对他们与临床医生就此问题的讨论了解甚少。
对660名患有慢性病的老年人进行全国性调查，这些人报告称上一年因费用问题未充分使用药物。我们评估了患者是否与临床医生讨论过与费用相关的药物未充分使用问题、一些患者未与临床医生谈论此问题的原因、当提出此问题时临床医生的反应，以及患者认为临床医生有多大帮助。
三分之二的受访者从未提前告知临床医生他们因费用问题计划减少用药，35%的人根本从未讨论过这个问题。在未告知临床医生的人中，66%报告称没人询问他们支付处方药的能力，58%报告称他们认为医疗服务提供者无法帮助他们。当患者与临床医生谈论药物费用时，72%的人认为这些谈话有帮助。然而，31%的人报告称他们的药物从未换成通用名药或更便宜的替代品，很少有患者得到其他形式的帮助，如有关帮助支付药费的项目信息（30%）或在哪里购买更便宜药物的信息（28%）。如果临床医生提供免费样品、询问支付处方药的问题并就如何支付患者当前治疗方案提供建议，患者最有可能认为临床医生有帮助。
约三分之一因费用问题未充分使用处方药的慢性病成年人从未提前与临床医生交谈，许多人根本从未提出这个问题。临床医生应在识别和帮助有支付处方药问题的患者方面发挥更积极的作用。
