Pittsburgh Veterans Affairs Medical Center and the Center for Health Equity Research and Promotion, Pittsburgh, PA, USA.
J Gen Intern Med. 2011 Dec;26(12):1458-64. doi: 10.1007/s11606-011-1801-y. Epub 2011 Jul 13.
Cost-related underuse of medications is common among older adults, who seldom discuss medication costs with their physicians. Some older adults may use free drug samples or industry-sponsored patient assistance programs (PAP) in hopes of lowering out-of-pocket costs, although the long-term effect of these programs on drug spending is unclear.
To examine older adults' use of industry-sponsored strategies to reduce out-of-pocket drug costs and the association between doctor-patient communication and use of these programs.
Cross-sectional analysis of a 2006 nationally representative survey of Medicare beneficiaries.
14,322 community-dwelling Medicare beneficiaries age ≥65.
We conducted bivariate and multivariate analyses of the association between receipt of free samples and participation in PAPs with sociodemographic characteristics, health status, access to care, drug coverage, medication cost burden, and doctor-patient communication.
51.4% of seniors reported receiving at least one free sample over the last 12 months and 29.2% reported receiving free samples more than once. In contrast, only 1.3% of seniors reported participating in an industry-sponsored PAP. Higher income respondents were more likely to report free sample receipt than low-income respondents (50.8% vs. 43.8%, p < 0.001) and less likely to report participating in a PAP (0.42% vs. 2.2%, p < 0.001). In multivariate analyses, those who reported talking to their doctor about the cost of their medications had more than twice the odds of receiving samples as those who did not (OR 2.17, 95% CI 1.95-2.42).
In 2006, over half of seniors in Medicare received free samples, but only 1.3% reported receiving any medications from a patient assistance program. Doctor-patient communication is strongly associated with use of these programs, which has important implications for clinical care regardless of whether these programs are viewed as drivers of prescription costs or a remedy for them.
在老年人中，与药物相关的使用不足很常见，他们很少与医生讨论药物费用。一些老年人可能会使用免费药物样本或行业赞助的患者援助计划（PAP），希望降低自付费用，尽管这些计划对药物支出的长期影响尚不清楚。
检查老年人使用行业赞助的策略来降低自付药物成本，以及医患沟通与使用这些计划之间的关系。
对 2006 年全国代表性的 Medicare 受益人的调查进行横断面分析。
年龄≥65 岁的 14322 名居住在社区的 Medicare 受益人。
我们对接受免费样本和参与 PAP 与社会人口统计学特征、健康状况、获得医疗保健的机会、药物覆盖范围、药物费用负担以及医患沟通之间的关系进行了单变量和多变量分析。
51.4%的老年人报告在过去 12 个月内收到至少一份免费样本，29.2%的老年人报告收到多次免费样本。相比之下，只有 1.3%的老年人报告参与了行业赞助的 PAP。高收入受访者比低收入受访者更有可能报告收到免费样本（50.8%比 43.8%，p<0.001），而参与 PAP 的可能性较低（0.42%比 2.2%，p<0.001）。在多变量分析中，与未与医生讨论药物费用的人相比，报告与医生讨论药物费用的人接受样本的可能性高出两倍以上（OR 2.17，95%CI 1.95-2.42）。
2006 年，超过一半的 Medicare 老年人收到免费样本，但只有 1.3%的人报告从患者援助计划中获得任何药物。医患沟通与这些计划的使用密切相关，无论这些计划被视为处方成本的驱动因素还是补救措施，这对临床护理都有重要意义。
