1 University of Michigan School of Public Health, Ann Arbor, MI, USA.
2 VA Center for Clinical Management Research, Ann Arbor, MI, USA.
Health Educ Behav. 2018 Feb;45(1):101-111. doi: 10.1177/1090198117704683. Epub 2017 Apr 26.
Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated.
We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting.
We report a pre-post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool.
Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% "learned a lot," 98% "topics relevant" 95% "applicable to their lives," 98% "liked the information"). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p < .05) and pharmacists (13% to 25.5%, p < .01), not skipping doses of medicines due to cost (11% to 4%, p < .03), and financial management (33.83 to 39.62, p < .007). There were no significant changes in perception of financial burden.
A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.
患有糖尿病等慢性病的成年人普遍存在与推荐的自我管理行为相关的费用相关不依从（CRN）。已经测试和评估了很少的行为干预措施来减轻 CRN。
我们开发了一种财务负担资源工具，并在临床环境中观察了它对糖尿病或糖尿病前期患者的患者为中心的结果的可接受性和初步效果。
我们报告了一项预前后瞻性单组设计的试点研究。我们从内分泌科诊所招募了 104 名患有糖尿病的成年人，他们报告说在管理糖尿病方面存在经济负担或存在 CRN 行为。我们向参与者提供了我们开发的财务负担资源工具，该工具为糖尿病管理和其他社会需求提供了量身定制的低成本资源选择。使用工具两个月后，评估了可接受性和自我报告的结果。
参与者的平均年龄为 50.5 岁（SD=15.3）。参与者在 15 个指标上对工具的接受度很高（例如，93%的人“学到了很多”，98%的人“主题相关”，95%的人“适用于他们的生活”，98%的人“喜欢信息”）。与基线相比，在 2 个月的随访中，与护士（19%到 29%，p<.05）和药剂师（13%到 25.5%，p<.01）讨论费用问题，因费用而不跳过剂量的药物（11%到 4%，p<.03）以及财务管理（33.83 到 39.62，p<.007）均有显著改善。对财务负担的感知没有明显变化。
财务负担资源工具患者接受度高，易于管理，并且可以促使行为改变。这项试点研究支持需要进行更有力的试验，以更长的随访时间来进一步评估此类工具在改善 CRN 和关键结果方面的有效性。
