Magazine article Clinical Psychiatry News

Cost Discussions Seldom Occur at Office Visits: Physicians Talked about Cost or Insurance for Just 12% of the 243 Prescriptions Issued to 185 Patients

Magazine article Clinical Psychiatry News

Cost Discussions Seldom Occur at Office Visits: Physicians Talked about Cost or Insurance for Just 12% of the 243 Prescriptions Issued to 185 Patients

Article excerpt

TUCSON, ARIZ. -- Physicians and their patients seldom discuss new medication costs and other acquisition issues, Dr. Derjung Mimi Tarn and associates reported in a poster presentation at the annual meeting of the North American Primary Care Research Group.

The investigators audiotaped the clinic visits of 185 patients who were receiving 243 new medication prescriptions and found that discussions about cost occurred in only 28 of the encounters. Patients rarely initiated conversations about cost, doing so for only four new prescriptions.

Physicians talked about cost or insurance for 12% of the 243 prescriptions, mentioned whether the medication was generic or brand name for only 2% of the prescriptions, talked about how to obtain the medication for 19%, about how long the supply would last for 9%, and about refills for 5%.

The analysis was based on the taped clinic visits that were conducted in 1999 at the University of California's Davis Medical Group and Kaiser Permanente, both in Sacramento, Calif., as part of the Physician Patient Communication Project. The project included 15 family physicians, 18 internists, and 11 cardiologists. The patients' mean age was 55 years, 83% were Caucasian, and more than 75% paid less than half of prescription drug costs. Overall, 31% were seen by family physicians, 47% by internists, and 23% by cardiologists (percentages do not total 100 because of rounding).

As patient age increased, the chances of physicians discussing cost decreased, according to a multivariate analysis that adjusted for medication class, over-the-counter and as-needed medication status, patient gender and race, prescription drug coverage, number of continued medications, and number of new medications prescribed. One possible explanation for that finding may be that time constraints and multiple health concerns were a factor, Dr. …

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