Kaal K Julia, Bansback Nick, Hudson Marie, Anis Aslam, Koehn Cheryl, Harrison Mark
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Clin Rheumatol. 2021 Jan;40(1):93-100. doi: 10.1007/s10067-020-05188-z. Epub 2020 Jun 6.
To examine the perceived importance and frequency with which out-of-pocket medication costs are discussed between rheumatologists and patients with rheumatoid arthritis (RA) in Canada.
A cross-sectional online survey was distributed to patients with RA and rheumatologists; both were asked to rate their perceived importance of discussing medication costs, and how often these discussions occurred. Predictors of (1) patients discussing costs with their rheumatologist and (2) the perceived importance of discussing medication cost for patients were explored.
Seventy-eight patients and 64 rheumatologists completed the survey; 68% patients and 75% of physicians rated the perceived importance of discussing medication costs as "quite" or "very important"; 22% of patients reported never talking about medication cost, but no physicians reported never discussing costs with patients. The only predictor of talking about cost among patients (at 10% level) was whether they perceived it as highly important (p = 0.058). Higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making (p = 0.044).
Discussions about cost do not always happen, even with diseases with potentially high medication costs like RA. Cost was more likely to be discussed by patients who perceived it as "very important," suggesting the onus might be on patients to initiate these conversations. Without any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, there is a need to reinforce recommendations that all physicians seek to discuss costs with all of their patients when suggesting medications. Key Points • There is a need for patients and physicians to discuss costs in the treatment decision-making process. Our findings suggest this does not always happen. • Among patients, medication cost was more likely to be discussed by those who perceived it as "very important" and higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making. • Our results did not reveal any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, suggesting that there is a need to reinforce recommendations that all physicians seek to discuss medication costs with all of their patients when suggesting medications.
研究在加拿大，风湿病医生与类风湿关节炎（RA）患者讨论自付药费的感知重要性和频率。
对RA患者和风湿病医生开展了一项横断面在线调查；二者均被要求对讨论药费的感知重要性以及这些讨论的发生频率进行评分。探究了（1）患者与风湿病医生讨论费用的预测因素，以及（2）患者对讨论药费的感知重要性的预测因素。
78名患者和64名风湿病医生完成了调查；68%的患者和75%的医生将讨论药费的感知重要性评为“相当”或“非常重要”；22%的患者报告从未谈论过药费，但没有医生报告从未与患者讨论过费用。患者中谈论费用的唯一预测因素（在10%水平）是他们是否认为其非常重要（p = 0.058）。对讨论自付费用的更高感知重要性与对共同决策的更积极态度相关（p = 0.044）。
即使对于像RA这样药费可能很高的疾病，关于费用的讨论也并非总是发生。那些认为费用“非常重要”的患者更有可能讨论费用，这表明发起这些对话的责任可能在患者身上。由于没有任何显著的预测因素表明哪些因素可能使医生更倾向于认为讨论药费很重要，因此有必要强化建议，即所有医生在给患者开药时都应设法与所有患者讨论费用。要点 • 患者和医生在治疗决策过程中需要讨论费用。我们的研究结果表明这种情况并非总是发生。 • 在患者中，那些认为药费“非常重要”的人更有可能讨论药费，并且对讨论自付费用的更高感知重要性与对共同决策的更积极态度相关。 • 我们的结果没有揭示任何显著的预测因素表明哪些因素可能使医生更倾向于认为讨论药费很重要，这表明有必要强化建议，即所有医生在给患者开药时都应设法与所有患者讨论药费。
