Patient-Oncologist Cost Communication, Financial Distress, and Medication Adherence
Patient-Oncologist Cost Communication, Financial Distress, and Medication Adherence
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DOI：
10.1200/jop.2014.001406
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发表时间：
2014-05-01
影响因子：
--
通讯作者：
Zafar, S. Yousuf
中科院分区：
文献类型：
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作者：
Bestvina, Christine M.;Zullig, Leah L.;Zafar, S. Yousuf
背景资料：鲜为人知的是，患者肿瘤学家讨论癌症治疗的自付（OOP）费用和药物治疗的依从性，一个重要组成部分的质量cancer care.Methods：我们调查了投保的成年人接受抗癌治疗之间的关联。患者被问及是否已与肿瘤科医生讨论过OOP费用。药物不依从性被定义为跳过剂量或服用比处方更少的药物以使处方持续更长时间，或由于成本而不填写处方。多变量分析评估了不遵守和成本discussions.Results之间的关联：在300名受访者（86%的响应），16%（n = 49）报告高或压倒性的财务困境。19%（n = 56）的患者报告与肿瘤科医生讨论了费用问题。27%（n = 77）的患者报告药物不粘连。为了使处方持续时间更长，14%（n = 42）跳过药物剂量，11%（n = 33）服用的药物少于处方; 22%（n = 66）由于费用而没有填写处方。5%（n = 14）报告化疗不依从。为了使处方持续时间更长，1%（n = 3）跳过化疗剂量，2%（n = 5）减少化疗; 3%（n = 10）由于成本而没有填写化疗处方。在调整后的分析中，（比值比[OR] = 2.58; 95% CI，1.14至5.85; P = 0.02），财务困境（OR = 1.64，95% CI，1.38 - 1.96; P = .001）和高于预期的经济负担（OR = 2.89; 95%CI，1.41至5.89; P = 0.01）与不依从的几率增加相关。患者与肿瘤科医生之间的费用沟通和经济困难与药物治疗不依从性相关，这表明成本讨论对于被迫做出成本相关行为改变的患者很重要。未来的研究应审查成本讨论的时间、内容和质量。
Background: Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care.Methods: We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions.Results: Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadher-ence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P = .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P = .01) were associated with increased odds of nonadherence.Conclusion: Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.