University of Kentucky, USA.
University of Kentucky, USA.
Soc Sci Med. 2020 Aug;258:113084. doi: 10.1016/j.socscimed.2020.113084. Epub 2020 May 29.
As healthcare costs continue to rise, so does the importance of having cost-of-care conversations during medical office visits, especially for patients from vulnerable populations and patients with high-cost illnesses such as cancer. Such conversations remain relatively rare, however, even though physicians and patients say they want to have them. Furthermore, there is a lack of evidence-based guidelines for encouraging cost conversations and improving their quality.
The purpose of this project was to conduct a systematic review of the cost-of-care conversations literature, focusing on empirical studies to characterize the state of the literature and provide a foundation for developing evidence-based guidelines for these important conversations.
We searched seven electronic databases and identified an initial list of 1,986 records, 54 of which met inclusion criteria. We reviewed those articles to identify study purpose, use of theory, conceptual and operational definitions of cost conversations, sample characteristics, research methods, variables relevant to cost conversations, and relevant study findings.
Results revealed that this literature (a) consists overwhelmingly of cross-sectional survey research set in the United States, (b) defines cost conversations chiefly as those focused on healthcare or medication costs (either in general or out-of-pocket), (c) is focused primarily on establishing incidence/frequency of cost conversations but also considers patient/provider desire for, attitudes/beliefs toward, and perceived barriers to cost conversations, and (d) lacks theoretical guidance. There were very few findings that could provide actionable evidence to guide quality conversations about reducing cost of care. We offer observations and recommendations for the next steps in cost conversations research so that patients and physicians can work together to promote quality care at affordable costs.
随着医疗保健成本的不断上升，在医疗办公室就诊期间进行医疗成本对话的重要性也越来越大，尤其是对于弱势群体患者和患有癌症等高成本疾病的患者。然而，尽管医生和患者表示希望进行此类对话，但这种对话仍然相对较少。此外，缺乏鼓励成本对话和提高其质量的循证指南。
本项目旨在对医疗成本对话文献进行系统综述，重点关注实证研究，以描述文献现状并为制定这些重要对话的循证指南提供基础。
我们搜索了七个电子数据库，确定了最初的 1986 条记录列表，其中 54 条符合纳入标准。我们审查了这些文章，以确定研究目的、理论的使用、成本对话的概念和操作定义、样本特征、研究方法、与成本对话相关的变量以及相关的研究结果。
结果表明，该文献（a）主要由美国的横断面调查研究组成，（b）主要将成本对话定义为关注医疗保健或药物成本（无论是一般的还是自付的），（c）主要集中在建立成本对话的发生率/频率，但也考虑了患者/提供者对成本对话的需求、态度/信念和感知障碍，以及（d）缺乏理论指导。几乎没有发现任何可以提供可行证据来指导关于降低医疗成本的高质量对话的发现。我们为成本对话研究的下一步提供了观察结果和建议，以便患者和医生能够共同努力，以可承受的成本提供高质量的护理。
