Addressing Medication Costs During Primary Care Visits: A Before–After Study of Team-Based Training

Carroll, Jennifer K.; Farah, Subrina; Fortuna, Robert J.; Lanigan, Angela M.; Sanders, Mechelle; Venci, Jineane V.; Fiscella, Kevin

doi:10.7326/m18-2011

Cited by 16 publications

(13 citation statements)

References 19 publications

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“…As health care costs continue to escalate, the need for conversations between clinicians and patients that explicitly address the costs of treatment increase alongside them. 30,31 Although our results show a clear correlation between SDM tool use and the incidence of cost conversations in clinical encounters; some of the SDM tools were used to support conversations about a particular issue (eg, efficacy of treatment), or conversations about risk, and not used to support conversations about other practical issues such as cost. Thus, this study should not lead to the conclusion that clinicians must use SDM tools with patients in order to have cost conversations or offer potential solutions to patients' cost concerns.…”

Section: Study Limitationsmentioning

confidence: 73%

Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Suárez

LaVecchia

Ponce

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To determine how shared decision-making (SDM) tools used during clinical encounters that raise cost as an issue impact the incidence of cost conversations between patients and clinicians. Patients and Methods: A randomly selected set of 220 video recordings of clinical encounters were analyzed. Videos were obtained from eight practice-based randomized clinical trials and one quasirandomized clinical trial (pre-and post-) comparing care with and without SDM tools. The secondary analysis took place in 2018 from trials ran between 2007 and 2015. Results: Most patient participants were white (85%), educated (38% completed college), middle-aged (mean age 56 years), and female (61%). There were 105 encounters with and 115 without the SDM tool. Encounters with SDM tools were more likely to include both general cost conversations (62% vs 36%, odds ratio [OR]: 9.6; 95% CI: 4 to 26) as well as conversations on medication costs specifically (89% vs 51%, P¼.01). However, clinicians using SDM tools were less likely to address cost issues during the encounter (37% vs 51%, P¼.04). Encounters with patients with less than a college degree were also associated with a higher incidence of cost conversations. Conclusion: Using SDM tools that raise cost as an issue increased the occurrence of cost conversations but was less likely to address cost issues or offer potential solutions to patients' cost concerns. This result suggests that SDM tools used during the consultation can trigger cost conversations but are insufficient to support them.

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Section: Study Limitationsmentioning

confidence: 73%

Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Suárez

LaVecchia

Ponce

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

View full text Add to dashboard Cite

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“…Their intervention demonstrated an increase in the frequency of cost conversations (Table 2) and a decrease in the frequency of patients expressing cost concern during medical encounters (58% vs 39%, P = .005 ) 18 . Finally, Carroll et al, found that after a single training session for clinicians regarding the importance of cost conversations and cost‐saving strategies, the frequency of cost conversations (Table 2) and the usage of cost reduction strategies increased (25% vs 16%, P = .002) 19 …”

Section: Resultsmentioning

confidence: 98%

Interventions supporting cost conversations between patients and clinicians: A systematic review

Barrera

Ponce

Suárez

et al. 2021

Int. J. Clin. Pract.

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Discussing costs during the medical encounter can help address patients' and physician's concerns about the costs and affordability for care. A recent national survey in the United States found that four out of 10 patients reported that it is somewhat or very difficult to afford health care. [1][2][3][4][5] Patient's financial hardship negatively affects the quality of life and their health outcomes. 4 Patients unable to afford health care may not have access to evidence-based treatment or might decide to postpone it. [6][7][8][9][10] In addition, to mitigate the impact of health care costs, patients resort to problematic actions: forgoing necessities, such as food and clothing, not paying bills or rationing their medications. [11][12][13] Discussing cost during medical encounters may help decrease the impact of high out-of-pocket costs on patients by aligning

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“…Team-based approaches could reduce the workload for busy clinicians as well as provide positive reinforcement for identification of potential socio-legal needs. Interdisciplinary, team-based approaches are needed to integrate CoC conversations effectively across the care continuum, normalize CoC conversations for both providers and patients, and build patient-provider trust ( Carroll et al, 2019 ; Hardee et al, 2005 ; Henrikson et al, 2019 ; Warsame et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Medical-Legal Partnerships Facilitate Patient-Provider Cost of Care Conversations: A Multisite Qualitative Study in the U.S.

et al. 2022

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This study examines the impact of medical-legal partnerships on facilitating and managing outcomes of patient-provider cost of care conversations. We conducted 96 semi-structured interviews with 18 patients and 78 medical-legal partnership personnel from 10 states between March and November of 2020. The presence of legal staff helped strengthen interdisciplinary collaborations and build confidence among providers around addressing health-harming legal needs through effective cost of care conversations. Medical-legal partnerships with well-established provider training opportunities reported effective cost of care conversations, improved patient outcomes, and increased return on investment for health systems. Lack of time, knowledge, and training were identified as barriers to clinicians engaging in cost of care conversations. Positive patient outcomes included improved access to public benefits, health benefits, financial benefits, special education services, stable housing, and food. Medical-legal partnerships facilitate effective patient-provider cost of care conversations that improve patients’ medical, legal, and social service outcomes.

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Addressing Medication Costs During Primary Care Visits: A Before–After Study of Team-Based Training

Cited by 16 publications

References 19 publications

Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Interventions supporting cost conversations between patients and clinicians: A systematic review

Medical-Legal Partnerships Facilitate Patient-Provider Cost of Care Conversations: A Multisite Qualitative Study in the U.S.

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