1
|
Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
Collapse
Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| |
Collapse
|
2
|
Lurie I, Maree S, Mendlovic S, Shefet D. Psychiatrists' awareness of the cost of medication, rates of social disability pension, and their attitudes regarding knowledge of treatment costs. Isr J Health Policy Res 2022; 11:35. [PMID: 36217171 PMCID: PMC9552487 DOI: 10.1186/s13584-022-00545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Medication is a significant component of the cost of mental health care. Studies from different countries indicate that physicians are often not aware of medication costs, despite the impact of such knowledge on treatment plans. The purpose of this study was to examine Israeli psychiatrists’ knowledge regarding the cost of medication and rates of disability pension, and the impact of these factors on treatment decisions. Methods Cross-sectional study. A questionnaire was distributed by e-mail to psychiatry specialists and residents, including: (a) socio-demographic and professional information; (b) knowledge regarding rates of National Insurance disability pension and medications’ costs; (c) attitudes regarding relevance of knowledge of treatment costs. Correlations between socio-demographic variables and knowledge regarding treatment costs and attitudes were examined. Results Of the 175 psychiatrists who completed the questionnaire, 55% were men. The level of knowledge regarding cost of psychotropic medication and disability pension rates was low. Sixty-eight percent rated economic considerations as important or very important, yet 75% were informed of medication prices by their patients, and 57% by pharmaceutical companies. Doctors who worked in regions other than the center of the state were more aware of the economic aspects of treatment. Physicians who reported easy access to information regarding drug prices were less likely to err in estimating the price of medications. Conclusions Psychiatrists in Israel are not sufficiently informed of the costs of psychotropic medications, despite their awareness of the relevance of affordability to treatment compliance. Awareness of economic issues relating to treatment should be included in residency programs, and access to relevant information of medication cost and disability pensions should be more accessible to physicians both on national and local levels, by the government and health maintenance ogranizations (HMOs).
Collapse
Affiliation(s)
- Ido Lurie
- Shalvata Mental Health Center, P.O.B 94, Hod Hasharon, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Saed Maree
- Shalvata Mental Health Center, P.O.B 94, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Mendlovic
- Shalvata Mental Health Center, P.O.B 94, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Shefet
- Shalvata Mental Health Center, P.O.B 94, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Wang Y, Perri M. The potential existence of ‘Small Individual Formulary’ in prescribing behaviour: a qualitative semi-structured interview study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
There is a widely held but previously unsubstantiated belief that prescribers tend to consider and use a limited set of medications when making prescribing decisions. This study aimed to enhance understanding of the process of prescribing decision making in a real-world context.
Methods
Using constructivist grounded theory methodology, we conducted semi-structured interviews with 11 healthcare providers in Georgia state. The providers, most of whom are physicians of different specialties, shared their perspectives about prescribing decision making and their perceptions about using a limited set of medications in daily practice.
Key findings
Three themes emerged from the qualitative analysis: (1) prescribers recognized the existence of ‘small individual formularies’ and considered it helpful in simplifying prescribing decision making; (2) healthcare providers employed an algorithm to initiate and step up drug therapy for patients; (3) formulary and patient affordability played a vital role in prescribing.
Conclusions
Physicians and other prescribers consider and use a limited set of prescription drugs based on their internal prescribing behaviour algorithm. Strategies could be developed to help stakeholders use this information to improve medication use.
Collapse
Affiliation(s)
- Yu Wang
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia , Athens, GA , USA
| | - Matthew Perri
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia , Athens, GA , USA
| |
Collapse
|
4
|
Callaghan BC, Reynolds E, Banerjee M, Kerber KA, Skolarus LE, Magliocco B, Esper GJ, Burke JF. Out-of-pocket costs are on the rise for commonly prescribed neurologic medications. Neurology 2019; 92:e2604-e2613. [PMID: 31043472 PMCID: PMC6556089 DOI: 10.1212/wnl.0000000000007564] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/08/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine out-of-pocket costs for neurologic medications in 5 common neurologic diseases. METHODS Utilizing a large, privately insured, health care claims database from 2004 to 2016, we captured out-of-pocket medication costs for patients seen by outpatient neurologists with multiple sclerosis (MS), peripheral neuropathy, epilepsy, dementia, and Parkinson disease (PD). We compared out-of-pocket costs for those in high-deductible health plans compared to traditional plans and explored cumulative out-of-pocket costs over the first 2 years after diagnosis across conditions with high- (MS) and low/medium-cost (epilepsy) medications. RESULTS The population consisted of 105,355 patients with MS, 314,530 with peripheral neuropathy, 281,073 with epilepsy, 120,720 with dementia, and 90,801 with PD. MS medications had the fastest rise in monthly out-of-pocket expenses (mean [SD] $15 [$23] in 2004, $309 [$593] in 2016) with minimal differences between medications. Out-of-pocket costs for brand name medications in the other conditions also rose considerably. Patients in high-deductible health plans incurred approximately twice the monthly out-of-pocket expense as compared to those not in these plans ($661 [$964] vs $246 [$472] in MS, $40 [$94] vs $18 [$46] in epilepsy in 2016). Cumulative 2-year out-of-pocket costs rose almost linearly over time in MS ($2,238 [$3,342]) and epilepsy ($230 [$443]). CONCLUSIONS Out-of-pocket costs for neurologic medications have increased considerably over the last 12 years, particularly for those in high-deductible health plans. Out-of-pocket costs vary widely both across and within conditions. To minimize patient financial burden, neurologists require access to precise cost information when making treatment decisions.
Collapse
Affiliation(s)
- Brian C Callaghan
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
| | - Evan Reynolds
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Mousumi Banerjee
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Kevin A Kerber
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Lesli E Skolarus
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Brandon Magliocco
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Gregory J Esper
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - James F Burke
- From the Health Services Research Program, Department of Neurology (B.C.C., K.A.K., L.E.S., J.F.B.), and the School of Public Health (E.R., M.B.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| |
Collapse
|
5
|
Miranda AC, Serag-Bolos ES, Cooper JB. Cost-related medication underuse: Strategies to improve medication adherence at care transitions. Am J Health Syst Pharm 2019; 76:560-565. [PMID: 31361859 DOI: 10.1093/ajhp/zxz010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Aimon C Miranda
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Erini S Serag-Bolos
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Julie B Cooper
- Department of Clinical Sciences, Fred Wilson School of Pharmacy at High Point University, High Point, NC
| |
Collapse
|
6
|
Tseng CW, Lin GA, Davis J, Taira DA, Yazdany J, He Q, Chen R, Imamura A, Dudley RA. Giving formulary and drug cost information to providers and impact on medication cost and use: a longitudinal non-randomized study. BMC Health Serv Res 2016; 16:499. [PMID: 27654857 PMCID: PMC5031286 DOI: 10.1186/s12913-016-1752-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providers wish to help patients with prescription costs but often lack drug cost information. We examined whether giving providers formulary and drug cost information was associated with changes in their diabetes patients' drug costs and use. We conducted a longitudinal non-randomized evaluation of the web-based Prescribing Guide ( www.PrescribingGuide.com ), a free resource available to Hawaii's providers since 2006, which summarizes the formularies and copayments of six health plans for drugs to treat 16 common health conditions. All adult primary care physicians in Hawaii were offered the Prescribing Guide, and providers who enrolled received a link to the website and regular hardcopy updates. METHODS We analyzed prescription claims from a large health plan in Hawaii for 5,883 members with diabetes from 2007 (baseline) to 2009 (follow-up). Patients were linked to 299 "main prescribing" providers, who on average, accounted for >88 % of patients' prescriptions and drug costs. We compared changes in drug costs and use for "study" patients whose main provider enrolled to receive the Prescribing Guide, versus "control" patients whose main provider did not enroll to receive the Prescribing Guide. RESULTS In multivariate analyses controlling for provider specialty and clustering of patients by providers, both patient groups experienced similar increases in number of prescriptions (+3.2 vs. +2.7 increase, p = 0.24), and days supply of medications (+141 vs. +129 increase, p = 0.40) averaged across all drugs. Total and out-of-pocket drug costs also increased for both control and study patients. However, control patients showed higher increases in yearly total drug costs of $208 per patient (+$792 vs. +$584 increase, p = 0.02) and in 30-day supply costs (+$9.40 vs. +$6.08 increase, p = 0.03). Both groups experienced similar changes in yearly out-of-pocket costs (+$41 vs + $31 increase, p = 0.36) and per 30-day supply (-$0.23 vs. -$0.19 decrease, p = 0.996). CONCLUSION Giving formulary and drug cost information to providers was associated with lower increases in total drug costs but not with lower out-of-pocket costs or greater medication use. Insurers and health information technology businesses should continue to increase providers' access to formulary and drug cost information at the point of care.
Collapse
Affiliation(s)
- Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, 677 Ala Moana Blvd, Ste. 815, Honolulu, HI, 96813, USA. .,Pacific Health Research and Education Institute, Honolulu, USA. .,Veteran Affairs Pacific Islands Health Care System, Honolulu, USA.
| | - Grace A Lin
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
| | - James Davis
- Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Qimei He
- Pacific Health Research and Education Institute, Honolulu, USA
| | - Randi Chen
- Pacific Health Research and Education Institute, Honolulu, USA
| | - Allison Imamura
- Library Business Services, University of California, Los Angeles, USA
| | - R Adams Dudley
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.,Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, USA
| |
Collapse
|
7
|
Hunter WG, Zhang CZ, Hesson A, Davis JK, Kirby C, Williamson LD, Barnett JA, Ubel PA. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits. Med Decis Making 2016; 36:900-10. [PMID: 26785714 DOI: 10.1177/0272989x15626384] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/04/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. OBJECTIVE We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. DESIGN Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. RESULTS Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). LIMITATION Focus on 3 conditions with potentially high out-of-pocket costs. CONCLUSIONS Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes.
Collapse
Affiliation(s)
- Wynn G Hunter
- Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)
| | - Cecilia Z Zhang
- Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)
| | - Ashley Hesson
- Michigan State University, College of Human Medicine, East Lansing, MI, USA (AH)
| | - J Kelly Davis
- Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
| | - Christine Kirby
- Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
| | - Lillie D Williamson
- Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
- University of Illinois, Department of Communication, Champaign, IL, USA (LDW)
| | | | - Peter A Ubel
- Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)
- Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
- Duke University, Sanford School of Public Policy, Durham, NC, USA (PAU)
| |
Collapse
|
8
|
Eriksen II, Melberg HO. The effects of introducing an electronic prescription system with no copayments. HEALTH ECONOMICS REVIEW 2015; 5:56. [PMID: 26174807 PMCID: PMC4502047 DOI: 10.1186/s13561-015-0056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND To examine the impact of introducing an electronic prescription system with no copayments on the number of prescriptions, the size of prescriptions, and the number of visits and phone calls to primary physicians. METHODS Fixed regression models using monthly data on per capita prescriptions claims and consultations between 2009 and 2013 at the municipality level, before and after the introduction of the electronic prescription system. RESULTS The electronic prescription system with no copayment increased the number of prescriptions by between 6.0 and 8.1 %. It decreased the average size of each prescription, but it did not decrease the number of consultations. CONCLUSION The reduced direct and indirect costs of obtaining prescriptions after the introduction of the electronic prescription system changed the financial incentives facing the patients and physicians. This led to significant changes in the level and size of prescriptions and illustrates the importance of financial incentives.
Collapse
Affiliation(s)
- Ida Iren Eriksen
- Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Hans Olav Melberg
- University of Oslo, OCBE and Department of Health Management and Health Economics, Box 1089 Blindern, 0317 Oslo, Norway
| |
Collapse
|
9
|
The black box of out-of-pocket cost communication. A path toward illumination. Ann Am Thorac Soc 2015; 11:1608-9. [PMID: 25549026 DOI: 10.1513/annalsats.201410-475ed] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Khan S. What can pharmacists' do about the Medicare Part D Donut hole and reimbursement? A six-state survey. Aging Clin Exp Res 2015; 27:373-81. [PMID: 25373609 DOI: 10.1007/s40520-014-0275-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND While Medicare Part D was signed into law in 2003 and initiated in 2006, there is a scarcity of information related to the implications of Part D on community pharmacies and subsequent effects. OBJECTIVE To determine the financial implications of Part D on community pharmacy, to identify pharmacists' and beneficiaries concerns from the pharmacists' perspective and to determine the pharmacists' responses to these impactions and concerns. METHODS A cross-sectional survey of pharmacists practicing in six states (Maine, New Jersey, New York, Maryland, Massachusetts and Pennsylvania) was conducted online between June and December 2011. The 37-question online survey collected demographic data, data about implications of Part D on community pharmacy and patients, and pharmacists' beliefs about ideal pharmacy practice and Part D plans. RESULTS Of the 4,888 online surveys, only 1,108 were assumed to have reached the intended recipients (response rate 25 %). Fifty-six percent reported that reimbursement was the most significant concern, and 34.5 % of the owners or part-owners were planning to close their pharmacy due to financial pressures exerted by Part D. A significant relationship was observed between dispensing of 90 days' supply of medications and better financial performance (χ (2) = 6.95, p = 0.0084). The most significant patient concerns were formulary and copayment (52.8 %) and Donut hole (52.4 %). Fifty-four percent respondents stated that his/her pharmacy helped patients obtain financial assistance while patients were in the Donut hole. CONCLUSION Respondents were most concerned about the poor reimbursement rates, but pharmacists who dispensed 90 day supply of medications reported acceptable financial performance. Pharmacists also reported helping patients obtain financial assistance while in the Donut hole.
Collapse
|
11
|
Broadwater-Hollifield C, Gren LH, Porucznik CA, Youngquist ST, Sundwall DN, Madsen TE. Emergency physician knowledge of reimbursement rates associated with emergency medical care. Am J Emerg Med 2014; 32:498-506. [DOI: 10.1016/j.ajem.2014.01.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022] Open
|
12
|
Portale JV, Harper LJ, Fields JM. Emergency physicians’ knowledge of the total charges of medical care. Am J Emerg Med 2013; 31:950-2. [DOI: 10.1016/j.ajem.2013.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/23/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022] Open
|
13
|
Choudhry NK, Saya UY, Shrank WH, Greenberg JO, Melia C, Bilodeau A, Kadehjian EK, Dolan ML, Dudley JC, Kachalia A. Cost-related medication underuse: prevalence among hospitalized managed care patients. J Hosp Med 2012; 7:104-9. [PMID: 21972200 DOI: 10.1002/jhm.948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 04/27/2011] [Accepted: 05/02/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been subject to little investigation. OBJECTIVE To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries. METHODS We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost-related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications. RESULTS One-hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost-related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost-related underuse than non-Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs. CONCLUSIONS Cost-related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge.
Collapse
Affiliation(s)
- Niteesh K Choudhry
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
A theoretical model for comparing UK costs of contact lens replacement modalities. Cont Lens Anterior Eye 2012; 35:28-34. [DOI: 10.1016/j.clae.2011.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/11/2011] [Accepted: 07/21/2011] [Indexed: 11/20/2022]
|
15
|
González López-Valcárcel B, Librero J, Sanfélix-Gimeno G, Peiró S. Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System? BMC Health Serv Res 2011; 11:333. [PMID: 22151628 PMCID: PMC3265431 DOI: 10.1186/1472-6963-11-333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/08/2011] [Indexed: 11/23/2022] Open
Abstract
Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.
Collapse
|
16
|
Polinski JM, Schneeweiss S, Maclure M, Marshall B, Ramsden S, Dormuth C. Time series evaluation of an intervention to increase statin tablet splitting by general practitioners. Clin Ther 2011; 33:235-43. [PMID: 21497707 DOI: 10.1016/j.clinthera.2011.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tablet splitting, in which a higher-dose tablet is split to get 2 doses, reduces patients' drug costs. Statins can be split safely. General practitioners (GPs) may not direct their patients to split statins because of safety concerns or unawareness of costs. Medical chart inserts provide cost-effective education to physicians. OBJECTIVE The aim of this study was to assess whether providing GPs with statin-splitting chart inserts would increase splitting rates, and to identify predictors of splitting. METHODS In 2005 and 2006, we faxed a statin chart insert to British Columbia GPs with a request for a telephone interview. Consenting GPs were mailed 3 statin chart inserts and interviewed by phone (the intervention). In an interrupted time series, we compared monthly rates of statin-splitting prescriptions among intervention and nonintervention GPs before, during, and after the intervention. In multivariate logistic regressions accounting for patient clustering, predictors of splitting included physician and patient demographics and the specific statin prescribed. RESULTS Of 5051 GPs reached, 282 (6%) agreed to the intervention. Before the intervention, GPs' splitting rate was 2.6%; after intervention, GPs' splitting rate was 7.5%. The rate for the nonintervention GPs was 4.4%. Intervention GPs were 1.68 (95% CI, 1.12-2.53) times more likely to prescribe splitting after the intervention than were nonintervention GPs. Other predictors were a patient's female sex (odds ratio [OR] = 1.26; 95% CI, 1.18-1.34), lower patient income (OR = 1.33; 95% CI, 1.18-1.34), and a lack of drug insurance (OR = 1.89; 95% CI, 1.69-2.04). CONCLUSIONS An inexpensive intervention was effective in producing a sustained increase in GPs' splitting rate during 22 months of observed follow-up. Expanding statin-splitting education to all GPs might reduce prescription costs for many patients and payors.
Collapse
Affiliation(s)
- Jennifer M Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Polinski JM, Donohue JM, Kilabuk E, Shrank WH. Medicare Part D's effect on the under- and overuse of medications: a systematic review. J Am Geriatr Soc 2011; 59:1922-33. [PMID: 21806563 DOI: 10.1111/j.1532-5415.2011.03537.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the literature regarding the effect of Medicare Part D on the under- and overuse of specific medications and corresponding health outcomes. DESIGN Systematic review. SETTING Medline search of the peer-reviewed literature from January 1, 2006, to October 8, 2010. PARTICIPANTS Medicare beneficiaries who obtained drug insurance from the Part D program. MEASUREMENTS The review evaluated changes in the use of specific drugs or drug classes after implementation of Part D, as described in original, peer-reviewed articles. RESULTS Nineteen articles met inclusion criteria. Part D's implementation was associated with greater use of essential medications such as clopidogrel and statins, especially in beneficiaries who had been previously uninsured, but increases in inappropriate antibiotic use for the treatment of acute respiratory tract infections and increases in claims for the often overused proton pump inhibitor drug class were also observed. In the Part D transition period, dually eligible beneficiaries' drug use remained largely unchanged. When beneficiary cost sharing increased in the coverage gap, use of essential and overused medications declined. CONCLUSION Increasing drug coverage led to greater use of underused essential medications and inappropriate, or overused, medications under Medicare Part D. Despite efforts to have it do so, the Part D benefit did not sufficiently discriminate between essential and nonessential medication use.
Collapse
Affiliation(s)
- Jennifer M Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA.
| | | | | | | |
Collapse
|
18
|
Efron N, Efron SE, Morgan PB, Morgan SL. A 'cost-per-wear' model based on contact lens replacement frequency. Clin Exp Optom 2010; 93:253-60. [PMID: 20597911 DOI: 10.1111/j.1444-0938.2010.00488.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim was to construct and advise on the use of a cost-per-wear model based on contact lens replacement frequency, to form an equitable basis for cost comparison. METHODS The annual cost of professional fees, contact lenses and solutions when wearing daily, two-weekly and monthly replacement contact lenses is determined in the context of the Australian market for spherical, toric and multifocal prescription types. This annual cost is divided by the number of times lenses are worn per year, resulting in a 'cost-per-wear'. The model is presented graphically as the cost-per-wear versus the number of times lenses are worn each week for daily replacement and reusable (two-weekly and monthly replacement) lenses. RESULTS The cost-per-wear for two-weekly and monthly replacement spherical lenses is almost identical but decreases with increasing frequency of wear. The cost-per-wear of daily replacement spherical lenses is lower than for reusable spherical lenses, when worn from one to four days per week but higher when worn six or seven days per week. The point at which the cost-per-wear is virtually the same for all three spherical lens replacement frequencies (approximately AUD$3.00) is five days of lens wear per week. A similar but upwardly displaced (higher cost) pattern is observed for toric lenses, with the cross-over point occurring between three and four days of wear per week (AUD$4.80). Multifocal lenses have the highest price, with cross-over points for daily versus two-weekly replacement lenses at between four and five days of wear per week (AUD$5.00) and for daily versus monthly replacement lenses at three days per week (AUD$5.50). CONCLUSIONS This cost-per-wear model can be used to assist practitioners and patients in making an informed decision in relation to the cost of contact lens wear as one of many considerations that must be taken into account when deciding on the most suitable lens replacement modality.
Collapse
Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation and School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
| | | | | | | |
Collapse
|
19
|
Lipton HL, Lai CJ, Cutler TW, Smith AR, Stebbins MR. Peer-to-peer interprofessional health policy education for Medicare part D. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2010; 74:102. [PMID: 21045944 PMCID: PMC2933011 DOI: 10.5688/aj7406102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 01/27/2009] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To determine whether a peer-to-peer education program was an expedient and effective approach to improve knowledge and promote interprofessional communication and collaboration. DESIGN Trained pharmacy students taught nursing students, medical students, and medical residents about the Medicare Part D prescription drug benefit (Part D), in 1- to 2-hour lectures. ASSESSMENT Learners completed a survey instrument to assess the effectiveness of the presentation and their attitudes toward the peer-to-peer instructional format. Learners strongly or somewhat agreed that the peer-to-peer format was effective in providing Part D education (99%) and promoted interprofessional collaboration (100%). Qualitative data highlighted the program's clinical relevance, value in promoting interprofessional collaboration, and influence on changing views about the roles and contributions of pharmacists. CONCLUSION The Part D peer educator program is an innovative way to disseminate contemporary health policy information rapidly, while fostering interprofessional collaboration.
Collapse
Affiliation(s)
- Helene L Lipton
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA 94118, USA.
| | | | | | | | | |
Collapse
|
20
|
Schmittdiel JA, Steers N, Duru OK, Ettner SL, Brown AF, Fung V, Hsu J, Quiter E, Tseng CW, Mangione CM. Patient-provider communication regarding drug costs in Medicare Part D beneficiaries with diabetes: a TRIAD Study. BMC Health Serv Res 2010; 10:164. [PMID: 20546616 PMCID: PMC2893177 DOI: 10.1186/1472-6963-10-164] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about drug cost communications of Medicare Part D beneficiaries with chronic conditions such as diabetes. The purpose of this study is to assess Medicare Part D beneficiaries with diabetes' levels of communication with physicians regarding prescription drug costs; the perceived importance of these communications; levels of prescription drug switching due to cost; and self-reported cost-related medication non-adherence. METHODS Data were obtained from a cross-sectional survey (58% response rate) of 1,458 Medicare beneficiaries with diabetes who entered the coverage gap in 2006; adjusted percentages of patients with communication issues were obtained from multivariate regression analyses adjusting for patient demographics and clinical characteristics. RESULTS Fewer than half of patients reported discussing the cost of medications with their physicians, while over 75% reported that such communications were important. Forty-eight percent reported their physician had switched to a less expensive medication due to costs. Minorities, females, and older adults had significantly lower levels of communication with their physicians regarding drug costs than white, male, and younger patients respectively. Patients with < $25 K annual household income were more likely than higher income patients to have talked about prescription drug costs with doctors, and to report cost-related non-adherence (27% vs. 17%, p < .001). CONCLUSIONS Medicare Part D beneficiaries with diabetes who entered the coverage gap have low levels of communication with physicians about drug costs, despite the high perceived importance of such communication. Understanding patient and plan-level characteristics differences in communication and use of cost-cutting strategies can inform interventions to help patients manage prescription drug costs.
Collapse
|
21
|
Abstract
BACKGROUND The literature on nonfulfillment of prescription medications spans over three decades of work. There is a wide variation in reported nonfulfillment rates, but no previous study has systematically reviewed this literature to explore the reasons behind this variation. OBJECTIVE The objective of this study was to review estimates of medication nonfulfillment rates and published reasons for nonfulfillment and explore whether nonfulfillment rates vary by study variables. METHODS Articles were identified through searches conducted on MEDLINE, CINAHL, Psych Info, and EMBASE, and review of relevant reference citations. Methodological variables, nonfulfillment rate, and unit of analysis (i.e., patient or prescription) were abstracted from each article selected for review. Mean and median nonfulfillment rates for groups categorized by unit of analysis and selected methodological variables (method for assessing nonfulfillment, sample characteristics, disease subgroup, sample size, country of data collection, recall period or time allowed before classifying as nonfulfillment, and year of study) were calculated. Reasons for nonfulfillment were abstracted from all articles that included a relevant discussion. FINDINGS A total of 79 studies reporting pure nonfulfillment rates (59 at the patient level and 20 at the prescription level) and six studies reporting nonfulfillment rates in combination with nonpersistence rates were included. There was a wide variation in nonfulfillment rates reported by the studies - from 0.5% to 57.1%. The three primary reasons for nonfulfillment identified from this review were perceived concerns about medications, lack of perceived need for medications, and medication affordability issues. CONCLUSION To the best of the authors' knowledge, this study is the first narrative systematic review on nonfulfillment of prescription medications. Despite the wide variation in individual study rates, the mean and median rates across different modes of data collection and sources of data were in a relatively narrow range (11% to 19%) and surprisingly close to the overall mean (16.4%) and median (15%.0) rates for all studies. The reasons for nonfulfillment identified through this review address barriers to nonfulfillment at the patient, physician, and health system level and thus bear important implications for policy makers.
Collapse
|
22
|
Patel MR, Coffman JM, Tseng CW, Clark NM, Cabana MD. Physician communication regarding cost when prescribing asthma medication to children. Clin Pediatr (Phila) 2009; 48:493-8. [PMID: 19164133 PMCID: PMC6004529 DOI: 10.1177/0009922808330110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with asthma require multiple medications, and cost may be a barrier to care. The purpose of this study was to determine how often physicians ask about cost when prescribing new asthma medication and to identify factors influencing queries. We surveyed pediatricians and family physicians and asked whether they asked about cost when prescribing new asthma medication and if cost was a barrier to prescribing. One third of physicians (35%) reported that concern for cost to the family was a barrier to prescribing. Half reported not asking their patients about drug costs. Pediatricians were less likely to ask about cost (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.20-0.92) when compared with family physicians. For every 10% increase in the number of privately insured patients, a physician was less likely to ask about cost (OR = 0.83; 95% CI = 0.74-0.94). Communication about medication costs should be included in childhood asthma management.
Collapse
Affiliation(s)
- Minal R. Patel
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan
| | - Janet M. Coffman
- Department of Family and Community Medicine, University of California, San Francisco, California, Department of Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Pacific Health Research Institute Honolulu, Hawaii
| | - Noreen M. Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan
| | - Michael D. Cabana
- Department of Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, , Department of Pediatrics, University of California, San Francisco, California, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| |
Collapse
|
23
|
Stebbins MR, Cutler TW, Corelli RL, Smith AR, Lipton HL. Medicare part D community outreach train-the-trainer program for pharmacy faculty. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2009; 73:53. [PMID: 19564996 PMCID: PMC2703286 DOI: 10.5688/aj730353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 06/12/2008] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess the train-the-trainer component of an initiative (Partners in D) to train pharmacy students to facilitate patient enrollment in the best Medicare Part D prescription drug plan (Part D). METHODS Faculty members from 6 California colleges or schools of pharmacy were taught how to train pharmacy students about Medicare Part D and how to conduct outreach events targeting underserved patient populations. A preintervention and postintervention survey instrument was administered to determine participants' (1) knowledge of the Part D program; (2) skill using the Medicare Prescription Drug Plan Finder tool; and (3) confidence in their ability to train pharmacy students. Implementation of the Partners in D curriculum in faculty members' colleges or schools of pharmacy was also determined. RESULTS Participants' knowledge of Part D, mastery of the Plan Finder, and confidence in teaching the material to pharmacy students all significantly improved. Within 8 weeks following the program, 5 of 6 colleges or schools of pharmacy adopted Partners in D coursework and initiated teaching the Partners-in-D curriculum. Four months afterwards, 21 outreach events reaching 186 Medicare beneficiaries had been completed. CONCLUSIONS The train-the-trainer component of the Partners in D program is practical and effective, and merits serious consideration as a national model for educating patients about Medicare Part D.
Collapse
Affiliation(s)
- Marilyn R Stebbins
- School of Pharmacy, University of California-San Francisco, 521 Parnassus, San Francisco, CA 94143, USA.
| | | | | | | | | |
Collapse
|
24
|
Resident physician and hospital pharmacist familiarity with patient discharge medication costs. ACTA ACUST UNITED AC 2009; 31:195-201. [DOI: 10.1007/s11096-009-9280-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 12/28/2008] [Indexed: 11/27/2022]
|
25
|
Wilbur K. Hospital Pharmacist Familiarity with Patient Discharge Medication Costs. J Pharm Technol 2008. [DOI: 10.1177/875512250802400503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Drug therapy poses a financial burden for many individuals. Cost-related medication nonadherence is ultimately associated with increased healthcare resource utilization and poor patient outcomes. Physicians are often unaware of the costs associated with their prescribed therapy, but little is documented regarding familiarity of hospital pharmacists with out-of-pocket medication expenses borne by patients in the community setting. Objective: To evaluate how familiar hospital pharmacists are with prescribed medication costs for discharged patients. Methods: Hospital pharmacists within a specific healthcare organization were invited to participate in an online survey. Ten brief patient case scenarios and associated discharge therapeutic regimens were outlined and respondents were asked to identify the costs that discharged patients would incur when having the prescriptions filled. The total number and proportion of estimates either above or below the actual medication cost as determined from community pharmacies were calculated. Results: Thirty-one pharmacists completed the survey. For the therapeutic regimens described, 47% of medication costs were underestimated, 33% were overestimated, and 20% were correctly estimated (within 10% of the actual value). Incorrect estimates were evident across all therapeutic classes and medical indications presented in the survey. The greatest mean absolute cost differences were underestimation of a linezolid treatment course for skin and soft tissue infection ($384.18 below the mean absolute cost) and overestimation of monthly bisoprolol heart failure therapy ($22.42). Conclusions: Hospital pharmacists are often unfamiliar with what discharged patients must pay for drug therapy.
Collapse
Affiliation(s)
- Kerry Wilbur
- KERRY WILBUR BScPharm ACPR PharmD, Assistant Professor, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar, fax 974/493-0449
| |
Collapse
|
26
|
Graber MA, Randles BD, Monahan J, Ely JW, Jennissen C, Peters B, Anderson D. What questions about patient care do physicians have during and after patient contact in the ED? The taxonomy of gaps in physician knowledge. Emerg Med J 2007; 24:703-6. [PMID: 17901270 PMCID: PMC2658437 DOI: 10.1136/emj.2007.050674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To categorise questions that emergency department physicians have during patient encounters. METHODS An observational study of 26 physicians at two institutions. All physicians were followed for at least two shifts. All questions that arose during patient care were recorded verbatim. These questions were then categorised using a taxonomy of clinical questions. RESULTS Physicians had 271 questions in the course of the study. The most common questions were about drug dosing (35), what drug to use in a particular case (28), "what are the manifestations of disease X" (23), and what laboratory test to do in a situation (21). Notably lacking were questions about medication costs, administrative questions, questions about services in the community, and pathophysiology questions. CONCLUSIONS Emergency department physicians tend to have questions that cluster around practical issues such as diagnosis and treatment. In routine practice they have fewer epidemiologic, pathophysiologic, administrative, and community services questions.
Collapse
Affiliation(s)
- Mark A Graber
- Department of Emergency Medicine, University of Iowa Carver College Medicine, Iowa City, Iowa 52242, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Domino ME, Stearns SC, Norton EC, Yeh WS. Why using current medications to select a medicare Part D plan may lead to higher out-of-pocket payments. Med Care Res Rev 2007; 65:114-26. [PMID: 17942795 DOI: 10.1177/1077558707307577] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While medications are one of the most stable categories of health care expenses, the actual composition of drug products used may be highly variable over time. Medicare beneficiaries selecting among Part D prescription drug plans (PDPs) are often advised to base plan selection on current medication lists. However, this approach may lead to higher out-of-pocket payments relative to payments under other plans if drug switches are common. This article uses a sample of Medicare beneficiaries from the 2003 Medical Expenditure Panel Survey to estimate how changes in actual drug use during a 1-year period affect estimated annual costs, given the initial choice of the lowest-cost PDP. While 57% of the sample had no difference in expenditure for plans selected based on initial versus end-of-the-year drug lists, 43% experienced average increases of $556 in annualized expenses due to drug switches. Implementable suggestions for improving the selection of Part D plans are provided.
Collapse
|