Wilson Ira B, Rogers William H, Chang Hong, Safran Dana Gelb
The Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA.
J Gen Intern Med. 2005 Aug;20(8):715-20. doi: 10.1111/j.1525-1497.2005.0128.x.
To report rates of cost-related skipping of medications and other treatments, assess correlates of skipping, examine changes in skipping between 1998 and 2000, and identify factors associated with changes in skipping.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional and longitudinal analyses of surveys of a probability sample of Medicare beneficiaries in 13 states in 1998 and 2000.
Self-reported rates of skipping medications and other treatments.
Cost-related skipping rates increased from 9.5% in 1998 to 13.1% in 2000. In separate multivariable models using 1998 and 2000 data, higher out-of-pocket costs, lower physician-patient relationship quality, low income, and lacking prescription drug coverage were associated with more skipping (P<.05 for all). Better physical and mental health, and greater age were associated with less skipping (P<.05). HMO membership was not associated with higher rates of skipping in 1998 (P=.84), but was in 2000 (P<.0004). In longitudinal analyses, increased medication costs and HMO membership were associated with the observed increase cost-related skipping between 1998 and 2000.
Cost-related skipping was associated with several factors, including drug coverage, poverty, poor health, and physician-patient relationship quality. The important role of physician-patient relationships in cost-related skipping has not been shown previously. Physicians should be aware of these risk factors for cost-related skipping, and initiate dialogue about problems paying for prescription medications and other treatments.
报告与费用相关的药物及其他治疗漏用率，评估漏用的相关因素，研究1998年至2000年间漏用情况的变化，并确定与漏用变化相关的因素。
设计、地点和参与者：对1998年和2000年13个州医疗保险受益人的概率样本进行横断面和纵向调查分析。
自我报告的药物及其他治疗漏用率。
与费用相关的漏用率从1998年的9.5%升至2000年的13.1%。在分别使用1998年和2000年数据的多变量模型中，自付费用较高、医患关系质量较低、低收入以及缺乏处方药保险与更多漏用相关（所有P值均<0.05）。身体和心理健康状况较好以及年龄较大与漏用较少相关（P<0.05）。1998年健康维护组织（HMO）成员资格与较高漏用率无关（P = 0.84），但2000年有关（P<0.0004）。在纵向分析中，药物费用增加和HMO成员资格与观察到的1998年至2000年间与费用相关的漏用增加有关。
与费用相关的漏用与多个因素有关，包括药物保险、贫困、健康状况差和医患关系质量。医患关系在与费用相关的漏用中的重要作用此前尚未得到证实。医生应了解这些与费用相关漏用的风险因素，并就处方药及其他治疗费用支付问题展开对话。
