An RCT To Decrease Out-Of-Pocket Prescription Costs

降低自付费用处方费用的随机对照试验

• 批准号: 7094777
• 负责人: G. Caleb Alexander
• 金额: $ 12.29万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-02-08 至 2011-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7094777
• 关键词: Medicare /Medicaid; behavioral /social science research tag; chemotherapy; communication behavior; cost effectiveness; focus groups; health care cost /financing; health care personnel; health care personnel education; health care service evaluation; health education; health services research tag; human middle age (35-64); human old age (65+); human subject; longitudinal human study; low socioeconomic status; medical outreach /case finding; patient care personnel relations; patient care planning; therapy compliance

DESCRIPTION (provided by the applicant): Out-of-pocket costs comprise approximately one-sixth of health care expenditures and nearly one-half of expenditures on prescription medicines. These costs pose a burden on many patients and are associated with non-adherence and other barriers to quality care. Dr. Alexander's previous work suggests that patient physician communication about out-of-pocket prescription costs is an important yet neglected aspect of current clinical practice. Such findings may be especially relevant to elderly patients who are more likely to be on multiple medications and have fixed incomes. In this proposed randomized trial, Dr. Alexander will develop, implement, and evaluate the effectiveness of an intervention designed to assist patients and physicians in safely reducing patients' out-of-pocket prescription costs. One hundred and eighty patients treated by 45 general internists and geriatricians will be recruited for the study from 8 physician practices. The intervention includes both patient- and physician-targeted strategies designed to overcome previously identified barriers to reducing patients' out-of-pocket costs. Primary outcomes of the study will be compared between baseline and six to eight weeks following patients' index office visit and include the impact of the intervention on out-of-pocket costs, medication appropriateness, health status, and burden from out-of pocket costs. Secondary outcomes will examine the effect of the interventions on rates of patient-physician discussions about costs, how changes in out-of-pocket costs are achieved (e.g. switching from brand name to generic equivalent), and barriers that may prevent enhanced intervention effectiveness (e.g. patient discomfort initiating discussions about prescription costs). The recently passed Medicare Modernization Act makes this research especially relevant because it leaves substantial gaps in coverage for beneficiaries of average means who incur high drug expenses. As a former Robert Wood Johnson Clinical Scholar with an established track record examining patient-physician communication about out-of-pocket costs, Dr. Alexander is in an ideal candidate to explore this important interface between bioethics, health policy, and clinical medicine.

描述（由申请人提供）：自付费用约占医疗保健支出的六分之一和处方药支出的近二分之一。这些费用给许多患者带来了负担，并与不依从性和其他优质护理障碍相关。亚历山大博士之前的工作表明，与患者医生就自付费用处方费用进行沟通是当前临床实践中一个重要但被忽视的方面。这些发现可能与更有可能服用多种药物且收入固定的老年患者尤其相关。在这项拟议的随机试验中，亚历山大博士将开发、实施和评估一项干预措施的有效性，该干预措施旨在帮助患者和医生安全地降低患者的自付费用处方费用。这项研究将从 8 个诊所招募 180 名患者，由 45 名普通内科医生和老年科医生治疗。该干预措施包括针对患者和医生的策略，旨在克服先前发现的降低患者自付费用的障碍。该研究的主要结果将在基线和患者就诊后六至八周之间进行比较，并包括以下因素的影响： 对自付费用、用药适当性、健康状况和自付费用负担进行干预。次要结果将检查干预措施对患者与医生讨论费用的比率的影响，如何实现自付费用的改变（例如从品牌名称转换为仿制药）以及可能妨碍增强干预效果的障碍（例如，患者不适引发有关处方费用的讨论）。最近通过的《医疗保险现代化法案》使这项研究特别有意义，因为它为支付高额药品费用的平均收入受益人留下了巨大的承保缺口。作为前罗伯特·伍德·约翰逊临床学者，亚历山大博士在检查患者与医生关于自付费用的沟通方面有着良好的记录，他是探索生物伦理学、卫生政策和临床医学之间这一重要界面的理想人选。