Richards Olivia K, Iott Bradley E, Toscos Tammy R, Pater Jessica A, Wagner Shauna R, Veinot Tiffany C
University of Michigan, School of Information, Ann Arbor, Michigan, USA.
Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA.
J Am Med Inform Assoc. 2022 May 11;29(6):1029-1039. doi: 10.1093/jamia/ocac010.
We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions.
We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding.
Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not always occur when patients felt they were needed. Consequently, patients faced a "cascade of work" to address affordability challenges. To prevent this, collaborative informatics tools could facilitate cost conversations and shared decision-making by providing information about a patient's financial constraints, enabling comparisons of medication/testing options, and addressing transportation logistics to facilitate patient follow-through.
Like providers, patients want informatics tools that address patient out-of-pocket costs. They want to discuss healthcare costs to reduce the frequency of unaffordable costs and obtain proactive assistance. Informatics interventions could minimize the cascade of patient work through shared decision-making and preventative actions. Such tools might integrate information about efficacy, costs, and side effects to support decisions, present patient decision aids, facilitate coordination among healthcare units, and eventually improve patient outcomes.
To prevent a burdensome cascade of work for patients, informatics tools could be designed to support cost conversations and decisions between patients and providers.
我们调查了患者与医疗服务提供者就药物和检查相关费用进行沟通的经历，以确定他们对未来信息学工具的偏好，以便做出对费用敏感的医疗决策。
我们在美国中西部医疗系统对不同年龄段（24 - 81岁）的患者进行了18次半结构化访谈。我们通过两轮定性编码确定了主题。
患者认为他们的医疗服务提供者可以帮助降低与药物相关的费用，但不明白医疗服务提供者如何影响与检查相关的费用。当医疗服务提供者能够调整医疗建议或提供资源时，患者认为关于药物的费用沟通是有益的。然而，当患者认为需要进行费用沟通时，这种沟通并不总是发生。因此，患者面临着一系列的“工作”来应对支付能力挑战。为了防止这种情况，协作式信息学工具可以通过提供患者财务限制信息、比较药物/检查选项以及解决交通物流问题来促进费用沟通和共同决策，从而方便患者跟进。
与医疗服务提供者一样，患者也希望有能解决患者自付费用的信息学工具。他们希望讨论医疗费用，以减少无法承受的费用发生频率，并获得积极的帮助。信息学干预可以通过共同决策和预防措施，将患者的一系列工作减到最少。这样的工具可能会整合疗效、费用和副作用信息以支持决策，提供患者决策辅助工具，促进医疗单位之间的协调，并最终改善患者的治疗效果。
为防止给患者带来繁重的一系列工作，可以设计信息学工具来支持患者与医疗服务提供者之间的费用沟通和决策。
