California State University, Sacramento, California (S.L.P.).
American College of Physicians, Philadelphia, Pennsylvania (A.W., S.R., C.D.S., W.N.).
Ann Intern Med. 2019 May 7;170(9_Suppl):S39-S45. doi: 10.7326/M18-2136.
Rising out-of-pocket costs are creating a need for cost conversations between patients and physicians.
To understand the factors that influence physicians to discuss and consider cost during a patient encounter.
Mixed-methods study using semistructured interviews and a survey.
United States.
20 internal medicine physicians were interviewed; 621 internal medicine physician members of the American College of Physicians completed the survey.
Interviews were analyzed by using thematic analysis, and surveys were analyzed by using descriptive statistics.
From the interviews, 4 themes were identified: Physicians are 1) aware that patients are struggling to afford medical care; 2) relying on clues from patients that hint at their cost sensitivity; 3) relying on experience to anticipate potentially high-cost treatments; and 4) aware that patients are making financial trade-offs to afford their care. Three quarters (n = 466) of survey respondents stated that they consider out-of-pocket costs when making most clinical decisions. For 31% (n = 191) of participants, there were times in the past year that they wanted to discuss out-of-pocket prescription drug costs with patients but did not. The most influential factors for ordering a test are the desire to be as thorough as possible (71% [n = 422]) and insurance coverage for the test (68% [n = 422]).
Findings are self-reported, the sample is limited to a single specialty, the survey response rate was low, information on the patient population was limited, and the survey instrument is not validated.
Physicians are attuned to the burden of health care costs and are willing to consider alternative options based on a patient's cost sensitivity.
Robert Wood Johnson Foundation.
不断上涨的自付费用使得患者和医生之间需要进行成本对话。
了解影响医生在患者就诊时讨论和考虑成本的因素。
采用半结构式访谈和调查的混合方法研究。
美国。
对 20 名内科医生进行了访谈；美国内科医师学会的 621 名内科医生成员完成了调查。
通过主题分析对访谈进行分析，通过描述性统计对调查进行分析。
从访谈中确定了 4 个主题：医生 1）意识到患者在努力负担医疗保健费用；2）依赖患者提供的线索来暗示他们的成本敏感性；3）依靠经验来预测潜在的高成本治疗方法；4）意识到患者为了负担他们的护理费用正在做出财务权衡。四分之三（n=466）的调查受访者表示，他们在做出大多数临床决策时会考虑自付费用。对于 31%（n=191）的参与者来说，在过去的一年中，他们有时想与患者讨论自付处方药费用，但没有这样做。开检验的最具影响力的因素是尽可能彻底的愿望（71%[n=422]）和检验的保险覆盖范围（68%[n=422]）。
研究结果是自我报告的，样本仅限于单一专业，调查的回复率很低，患者人群的信息有限，调查工具未经过验证。
医生对医疗保健费用的负担很敏感，并愿意根据患者的成本敏感性考虑替代方案。
罗伯特伍德约翰逊基金会。
