Cost of Treatment Conversations Between Primary Care Clinicians and Patients Living with Diabetes
November 27, 2021- 00:00Hi everyone, my name is Maria Dalzell.
- 00:04I'm excited to share with you my
- 00:06project cost of treatment conversations
- 00:07between primary care clinicians
- 00:09and patients living with diabetes.
- 00:11My advisors and coauthors were
- 00:13Doctor Bradley Richardson, Dr.
- 00:15Rossana Gonzalez, colosso.
- 00:16So some background treatment.
- 00:18Affordability has both financial and
- 00:21medical implications for patients
- 00:23increasing out of pocket expenses are
- 00:26associated with inadequate medication
- 00:27use and among all chronic diseases
- 00:29contributing to these high costs.
- 00:31Diabetes is one of the nation's
- 00:33most expensive.
- 00:34Yet little is known about the
- 00:36frequency of cost of treatment,
- 00:38conversations between patients and their
- 00:40clinicians in the diabetes care setting,
- 00:42specially in outpatient care,
- 00:44we set out to describe the prevalence
- 00:46of positive treatment conversations.
- 00:48Between patients living with
- 00:49diabetes and primary care,
- 00:51clinicians given the impact that
- 00:53treatment affordability may have on
- 00:55effective and safe disease management,
- 00:57we also explored the attitudes
- 00:59of patients and their clinicians
- 01:01towards addressing cost of diabetes
- 01:03treatment in a primary care setting.
- 01:06This was a cross sectional study which
- 01:08was conducted at one outpatient federally
- 01:10qualified health care clinic within
- 01:11a major New England health care system.
- 01:14The study was granted Institutional
- 01:16Review Board exemption.
- 01:17We retrospectively identified potential
- 01:19patients living with diabetes who
- 01:21had been seen in this clinic between
- 01:24September and December of 2020.
- 01:26And those who were identified through
- 01:28the search were then randomized to
- 01:30occult order and a telephone survey was
- 01:32delivered both in English and in Spanish
- 01:35to be inclusive with Hispanic patients.
- 01:37Clinicians who had seen patients between
- 01:41September and December 2020 were all
- 01:44invited to participate via email survey.
- 01:48Response to questions or dichotomous,
- 01:50continuous and categorical
- 01:52means standard deviation,
- 01:53relative frequencies,
- 01:54and proportions were used to discuss
- 01:57descriptive statistics to analyze
- 01:59the clinician and patient groups
- 02:01sample so some of the results are
- 02:03shown by the figures on the right.
- 02:05As you can see,
- 02:06figure one shows the proportion of
- 02:08patients who endorsed concerns regarding
- 02:10the cost of dirt diabetes treatment
- 02:12along with the patient reported
- 02:14frequency of cost of human conversations.
- 02:16So about 1/3 of patients reported
- 02:18some kind of concern over
- 02:21affording their diabetes treatment,
- 02:22yet 13% of patients reported having had
- 02:25these costs of treatment conversations
- 02:27with their primary care clinician.
- 02:29Figure two shows the clinician
- 02:31reported frequency of cost of
- 02:33treatment conversations as well as
- 02:36their attitudes towards how often.
- 02:39How we should discuss past training
- 02:42conversations with our patients.
- 02:44Almost every clinician agreed
- 02:45or strongly agreed that cost of
- 02:47treatment is an issue for their
- 02:49patients with diagnosed diabetes.
- 02:51When asked who
- 02:52these conversations, who should be having
- 02:55these conversations? The majority
- 02:57of patients picked their primary
- 02:59care clinician, whereas the
- 03:02clinician responses were more mixed
- 03:03with their top four answers being
- 03:05pharmacist primary care provider,
- 03:07insurance company or patient educator.
- 03:10So this study found that cost of treatment
- 03:12was under discussed between primary
- 03:14care clinicians and their patients.
- 03:16This was despite the proportion of
- 03:18patients that expressed concern over their
- 03:20costs of diabetes treatment clinicians.
- 03:22In our study expressed high awareness that
- 03:24cost of medication can affect medication use.
- 03:27Yet most reported only sometimes or
- 03:30rarely bringing it up in practice.
- 03:33While patients prefer to have these
- 03:34discussions with their primary care provider,
- 03:36who's ultimately the prescriber,
- 03:38other health care team members
- 03:40could share their responsibility as
- 03:42of addressing these costs through
- 03:44patient education and advising.
- 03:46Primary care clinicians could
- 03:47also initiate these conversations,
- 03:49and subsequently they can integrate
- 03:51other health care workers and exploring
- 03:53strategies such as switching to
- 03:55lower costs or alternative therapy,
- 03:57assisting patients in applying
- 03:59for insurance or charity care or
- 04:01facility in copay.
- 04:03We acknowledge several limitations.
- 04:04This study has a small sample size from
- 04:07a single primary care clinic and patient
- 04:10clinician groups were not matched,
- 04:12thus were unable to deduce any correlations.
- 04:15Selection bias may have been
- 04:17introduced from the survey.
- 04:19Through the telephone or the email
- 04:22correspondence and our study sample
- 04:24only focused on physicians and further
- 04:26studies should include other types of
- 04:28clinicians such as PS or nurse practitioners.
- 04:31Thank you so much for listening.
- 04:33My references and acknowledgements
- 04:34are at the bottom.