Most internal medicine physicians recognize that the costs of care may be a burden to patients and are willing to discuss options with them; but few raise the issue, results of a new survey show. Of 621 physicians responding to an email questionnaire; so 89% said they knew of at least one patient who did not fill a prescription because of the cost; also 84% knew of at least one patient who went without medical care because he or she could not afford the tests, treatment, or follow-up care.
However, the survey also revealed that many physicians do not routinely bring up these concerns; so preferring instead to look for “clues” that the patient may be struggling with costs; so such as reluctance to follow through with certain treatments or tests, or poor control of chronic illnesses such as diabetes, the survey authors write.

Order to meet medical expenses

The drawback to this approach, they caution, is that “such clues may not be present if patients are making sacrifices in other aspects of their lives in order to meet medical expenses,” write Susan L. Perez, PhD, and coauthors in an article published online yesterday in Annals of Internal Medicine. The article appears in a special supplement on cost-of-care conversations, which includes tools for facilitating those conversations.

Perez and colleagues find that physicians also frequently cited lack of transparency of healthcare costs as a barrier to having these conversations with patients. However, the authors write, not knowing precise costs does not prevent including cost concerns in conversations about treatment decisions.

There were other prominent themes emerging from the study; Physicians often relied on their own professional experience to anticipate what treatments be most expensive; so clinicians are usually aware that patients may be making financial trade-offs in order to afford care, Perez and colleagues note.
There were two components to the study designed by Perez, of the Department of Health Science, California State University, Sacramento, and colleagues. The first consisted of hour-long telephone interviews conducted with 20 internal medicine physicians across the United States. The participants were randomly selected from a national database of internal medicine physicians.

The second component consist of a questionnaire develop from the themes; hence identify in the interviews and from a literature review. The survey was emailed to 3000 randomly selected members of the American College of Physicians. Of 2927 eligible physicians, 621 responded, for a response rate of 21%. Responders and nonresponders did not differ in terms of age; so race, subspecialty, professional activity, or geographic region, the authors write.
Of these participants, 478 (77%) report knowledge of cases; which a patient had take medication less often or in smaller doses than recommended because of the expense. Similarly, 555 (89%) and 519 (84%), respectively; knew of at least one patient who did not fill a prescription or went without treatment because of cost concerns. Yet, just 50% of the survey respondents “reported having frequent discussions about [out-of-pocket] costs on a daily basis with their patients, Perez and colleagues write.
In a breakdown of factors consider when prescribing drugs; so 564 (91%) respondents cited cost to the patient as the most or second most important consideration, other than medical necessity. In a similar question pertaining to medical tests; so 550 respondents (89%) report that cost was a somewhat, moderately, or extremely important factor in the decision to order certain tests, beyond medical need.
The supplement also includes an article on how physicians can have effective cost-of-care conversations with patients. “It is clearly time for physicians to screen for health care-related financial hardship in a systematic way,” write Caroline E. Sloan, MD, of Duke University School of Medicine, Durham, North Carolina, and Peter A. Ubel, MD, of Fuqua School of Business, Duke University.