Context
Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006.
Objective
To determine the prevalence of physician–patient dialogue about medication cost and medication adherence among elderly adults nationwide.
Design
Cross-sectional survey.
Participants
National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older.
Main Outcome Measures
Rates of physician–patient dialogue about nonadherence and cost-related medication switching.
Results
Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28–5.93, P < .001).
Conclusions
We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters.
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Acknowledgments
This research was supported the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The authors gratefully acknowledge Spike Duzor, Maribel Franey, and Dural Suite (CMS) for their assistance with the authors’ data request. The contents of this paper are the sole responsibility of the authors and do not necessarily represent the views of the Commonwealth Fund, the Henry J. Kaiser Family Foundation, or Tufts–New England Medical Center.
Potential Financial Conflicts of Interest
None disclosed.
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Appendix
Appendix
Medication adherence items (response options for 2–8 were yes, often; yes, sometimes; and no, never).
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1.
During the last 12 months, how many times did you decide not to fill a prescription because it was too expensive? Response options were none, 1 time, 2 times, 3–4 times, 5–9 times, 10 or more times.
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2.
During the last 12 months, have you skipped doses of a medicine to make the prescription last longer?
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3.
During the last 12 months, have you taken a smaller dose of medicine so that the prescription would last longer (for example, by cutting pills in half)
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4.
During the last 12 months, have you spent less on food, heat, or other basic needs so that you would have enough money for your medicines?
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5.
During the last 12 months, did you decide not to fill a prescription because you felt you were taking too many medications?
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6.
During the last 12 months, did you decide not to fill a prescription because you didn’t think you needed the medicine?
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7.
During the last 12 months, have you skipped doses or stopped taking a medicine because it was making you feel worse?
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8.
During the last 12 months, have you skipped doses or stopped taking a medicine because you didn’t think it was helping you?
Physician–patient dialogue items (response options were yes and no).
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1.
During the last 12 months, did your personal doctor talk with you about all of the different medicines you are using, including medicines prescribed by other doctors?
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2.
During the last 12 months, did you talk with any of your doctors about the cost of your prescription medicines?
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3.
During the last 12 months, did you talk with any of your doctors about changing one of your prescription medicines because the medicine was making you feel worse or was not working?
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4.
During the last 12 months, did any of your doctors switch you from one prescription medicine to a different one that would cost you less?
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Wilson, I.B., Schoen, C., Neuman, P. et al. Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors. J GEN INTERN MED 22, 6–12 (2007). https://doi.org/10.1007/s11606-006-0093-0
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DOI: https://doi.org/10.1007/s11606-006-0093-0