Parikh Toral J, Helfrich Christian D, Quiñones Ana R, Marshall-Fabien Gillian L, Makaroun Lena K, Black Marissa A, Thielke Stephen M
Department of Gerontology and Geriatric Medicine, University of Washington, Health Services Research and Development, VA Puget Sound Health Care System.
Department of Health Services, University of Washington, Health Services Research and Development, VA Puget Sound Health Care System.
Medicine (Baltimore). 2019 Aug;98(31):e16469. doi: 10.1097/MD.0000000000016469.
Despite higher health care needs, older adults often have limited and fixed income. Approximately a quarter of them report not filling or delaying prescription medications due to cost (cost-related prescription delay, CRPD). To ascertain the association between CRPD and satisfaction with health care, secondary analysis of the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Advantage Survey was performed.Regression models quantified the association between CRPD and rating of personal doctor, specialist, and overall health care. Models were adjusted for demographic, health-related, and socioeconomic characteristics. 274,996 Medicare Advantage enrollees were mailed the CAHPS survey, of which 101,910 (36.8%) returned a survey that had responses to all the items we analyzed. CRPD was assessed by self-report of delay in filling prescriptions due to cost. Health care ratings were on a 0-10 scale. A score ≤ 5 was considered a poor rating of care.In unadjusted models, CRPD more than doubled the relative risk (RR) for poor ratings of personal doctor (RR 2.34), specialist (RR 2.14), and overall health care (RR 2.40). Adjusting for demographics and health status slightly reduced the RRs to 1.9, but adjusting for low-income subsidy and lack of insurance for medications did not make a difference.CRPD is independently associated with poor ratings of medical care, regardless of health, financial or insurance status. Providers might reduce patients' financial stress and improve patient satisfaction by explicitly discussing prescription cost and incorporating patient priorities when recommending treatments.
尽管老年人有更高的医疗保健需求，但他们的收入往往有限且固定。约四分之一的老年人报告称，由于费用问题（与费用相关的处方延迟，CRPD），他们不填写或延迟服用处方药。为了确定CRPD与医疗保健满意度之间的关联，我们对2012年医疗服务提供者和系统消费者评估（CAHPS）医疗保险优势调查进行了二次分析。回归模型量化了CRPD与个人医生、专科医生评分以及整体医疗保健评分之间的关联。模型针对人口统计学、健康相关和社会经济特征进行了调整。向274,996名医疗保险优势参保者邮寄了CAHPS调查问卷，其中101,910人（36.8%）返回了一份对我们分析的所有项目都有回复的调查问卷。CRPD通过因费用导致的处方填写延迟的自我报告来评估。医疗保健评分采用0至10分制。得分≤5分被视为对医疗保健的差评。在未调整的模型中，CRPD使个人医生差评的相对风险（RR）增加了一倍多（RR 2.34），专科医生差评的相对风险增加了一倍多（RR 2.14），整体医疗保健差评的相对风险增加了一倍多（RR 2.40）。调整人口统计学和健康状况后，RR略有降低至1.9，但调整低收入补贴和药物保险缺失情况并没有产生差异。无论健康、财务或保险状况如何，CRPD都与医疗保健差评独立相关。医疗服务提供者在推荐治疗方案时，通过明确讨论处方费用并纳入患者的优先事项，可能会减轻患者的经济压力并提高患者满意度。
