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Ann Intern Med. 2019 May 7;170(9_Supplement):S46-S53. doi: 10.7326/M18-2011.

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

Author information

1
University of Colorado, Aurora, Colorado (J.K.C.).
2
University of Rochester, Rochester, New York (S.F., M.S.).
3
Center for Primary Care, University of Rochester, Rochester, New York (R.J.F.).
4
National Research Network, American Academy of Family Physicians, Leawood, Kansas (A.M.L.).
5
University of Rochester Medical Center, Rochester, New York (J.V.V., K.F.).

Abstract

Background:

Medications contribute to patients' out-of-pocket costs, yet most clinicians do not routinely screen for patients' cost-of-medication (COM) concerns.

Objective:

To assess whether a single training session improves COM conversations.

Design:

Before-after cross-sectional surveys of patients and qualitative interviews with clinicians and staff.

Setting:

7 primary care practices in 3 U.S. states.

Participants:

In total, 700 patients were surveyed from May 2017 to January 2018: 50 patients per practice before the intervention and another 50 patients per practice after the intervention. Eligibility criteria included age 18 years or older and taking 1 or more long-term medications. Qualitative interviews with 45 staff members were conducted.

Intervention:

A single 60-minute training session for clinicians and staff from each practice on COM importance, team-based screening, and cost-saving strategies.

Measurements:

Patient data (demographics, number of long-term medications, total monthly out-of-pocket medication costs, and history of cost-related medication nonadherence) were obtained immediately before and 3 months after the intervention. Practice staff were interviewed 3 months after the intervention.

Results:

A total of 700 patient surveys were completed. Frequency of COM discussion improved in 6 of the 7 practices and remained unchanged in 1 practice. Overall, COM conversations with patients increased from 17% at baseline to 32% postintervention (P = 0.00). There was substantial heterogeneity among sites in before-after differences in patient-reported out-of-pocket COM. Qualitative analyses from key informant interviews showed wide variation in implementation of screening approaches, workflow, adoption of a team-based approach, and strategies for addressing COM.

Limitation:

It is not known whether improvements in COM conversations were sustained beyond 3 months.

Conclusion:

A single team training to screen and address patients' medication cost concerns improved COM discussions over the short term. Further research is needed to assess sustained effects and impact on patient costs and medication adherence and to determine whether more intensive, scalable interventions are needed.

Primary Funding Source:

Robert Wood Johnson Foundation.

PMID:
31060055
DOI:
10.7326/M18-2011

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