Espinoza Suarez Nataly R, Urtecho Meritxell, LaVecchia Christina M, Fischer Karen M, Kamath Celia C, Brito Juan P
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
VITAM-Centre for Sustainable Health Research, Laval University, Quebec City, QC, Canada.
Mayo Clin Proc Innov Qual Outcomes. 2022 Jun 25;6(4):320-326. doi: 10.1016/j.mayocpiqo.2022.05.005. eCollection 2022 Aug.
To investigate the impact of cost conversations occurring with or without the use of encounter shared decision-making (SDM) tools in medication adherence.
Using a coding scheme that included the occurrence and characteristics of cost conversation, we analyzed a randomly selected sample of 169 video recordings of clinical encounters. These videos were obtained during the conduct of practice-based randomized clinical trials comparing care with and without SDM tools for patients with diabetes, osteoporosis, and depression. Medication adherence was described in 2 ways: as a binary (yes/no) outcome, in which the patient met at least 80% adherence, or as a continuous variable, which was the percent of days that the patient adhered to their medication. The secondary analysis took place in 2018 from trials that ran between 2007 and 2015.
Most patients were White (155, 93.4%), educated (104, 63.4% completed college), middle-aged (mean age, 58 years), female (104, 61.5%), and from diabetes (86, 50.9%), depression (43, 25.4%), and osteoporosis (40, 23.7%) trials. Cost conversations occurred in 119 clinical encounters (70%) and were more frequent in those encounters in which SDM tools were used (=.03). Furthermore, 97 (57.4%) of the participants reported more than 80% medication adherence and 70.3±29.34 percentage of days with adherent medication of 70 days. In the multiple regression model, the only factor associated with adherence (binary or continuous) was the condition of the trial in which people participated. For the participants who had cost conversations, the use of an SDM tool, their sex, the nature of cost conversation (direct or indirect), the nature of cost concerns (treatment or patient issue), and the clinician-offered strategies (yes or no) were not associated with adherence.
In this videographic analysis of SDM practice-based clinical trials, cost conversations were not associated with the general measures of medication adherence. Future studies should assess whether a tailored cost conversation intervention would impact the cost-related nonadherence among patients.
探讨在药物依从性方面，使用或不使用会诊共享决策（SDM）工具进行费用沟通的影响。
我们采用了一种包含费用沟通发生情况及特征的编码方案，对随机抽取的169份临床会诊视频记录样本进行分析。这些视频是在开展基于实践的随机临床试验过程中获取的，该试验比较了糖尿病、骨质疏松症和抑郁症患者使用和不使用SDM工具的护理情况。药物依从性通过两种方式描述：作为二元（是/否）结果，即患者的依从性至少达到80%；或作为连续变量，即患者坚持服药的天数百分比。二次分析于2018年对2007年至2015年间进行的试验开展。
大多数患者为白人（155例，93.4%），受过教育（104例，63.4%完成大学学业），中年（平均年龄58岁），女性（104例，61.5%），分别来自糖尿病（86例，50.9%）、抑郁症（43例，25.4%）和骨质疏松症（40例，23.7%）试验。119次临床会诊（70%）中发生了费用沟通，且在使用SDM工具的会诊中更频繁（P =.03）。此外，97名（57.4%）参与者报告药物依从性超过80%，70天中有70.3±29.34%的天数坚持服药。在多元回归模型中，与依从性（二元或连续）相关的唯一因素是人们参与试验的疾病情况。对于进行了费用沟通的参与者，SDM工具的使用、他们的性别、费用沟通的性质（直接或间接）、费用关注点的性质（治疗或患者问题）以及临床医生提供的策略（是或否）均与依从性无关。
在这项基于SDM实践的临床试验的视频分析中，费用沟通与药物依从性的一般指标无关。未来的研究应评估针对性的费用沟通干预是否会影响患者中与费用相关的不依从情况。
