Americans are taking more pharmaceuticals than ever, but a pair of new studies concludes that doctors often hurriedly hand out prescriptions with no advice on potential side effects and little concern for the patient's ability to pay for the drugs they're prescribing.
After evaluating 185 taped conversations involving physicians and their patients, researchers at UCLA recently concluded that some important bases were frequently left uncovered in the doctor/patient relationship. Doctors covered the basics about drug costs and a patient's access to prescription drugs in only one-third of all cases. Focusing on cost and insurance coverage took place in a little more than one in 10 office visits. The logistics of obtaining drugs — including whether patients had access to a local pharmacy — occurred only about one in five times.
But if doctors were unlikely to offer the information to their patients or query them about their ability to buy drugs, said the lead researcher in the study, patients were even less likely to ask for it. Patients initiated discussions about costs or insurance in only 2 percent of the cases.
"I think sometimes patients feel they should know the information," said Dr. Derjung Tarn, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the studies' lead author. "They feel intimated by the situation. They may be shy."
In most cases — 87 percent — doctors explained to their patients why they were being prescribed a drug. But doctors covered potential side effects and the duration they were expected to take the drugs for only one in three prescriptions. Psychiatric drugs warranted the most in-depth explanations, followed by pulmonary and cardiovascular therapies.
None of this was a big surprise, said the author of the study. The advent of managed care has forced many physicians to curtail each office visit so they can see more patients in order to maintain their incomes. And with visits growing shorter, it was only natural that vital information was being ignored.
"The visits are very time compressed," said Tarn. "Physicians may forget or feel they don't have the time." And when it comes to cost, physicians often simply aren't aware whether their patients have trouble paying for drugs or not.
"When I was in residency, I had several encounters with patients where they were very confused," said Tarn. She suspects that that same deep confusion is likely common throughout the medical system. Most of the patients who were taped — 83 percent — were white; more than three in four paid for less than half the cost of their drugs.
Add their collective experiences, summed up Tarn, and you can see why patients are experiencing some big problems when it comes to staying compliant on their drug regime.
"The primary risk is that patients may not adhere to their medications," she explained. "They could potentially have poorer health outcomes."
Health experts have issued a number of warnings about a huge and deadly tide of medical errors involving drugs. Just last July, a new report by the Institute of Medicine estimated there were some 1.5 million medication mistakes a year in the United States. Those mistakes cost at extra $3.5 billion in hospitalization costs alone.
There are some obvious clues that doctors can navigate by, said Tarn. Doctors may be quick to assess a patient's income status based on whether the patient is being reimbursed by Medicaid or a private health plan. But more often, she said, doctors just don't know and don't ask.
Under the circumstances, said Tarn, it isn't likely that doctors will be able to switch gears and stay longer with patients. But patients need to insist that doctors take the time to explain more about the meds they're being prescribed and whether they can actually afford to take them.
Health plans can also step in, said the researcher. "I think it's going to be a bigger issue than at the physician level; it has to come from health plans partnering with physicians on better information systems."
"Some health plans are working with physicians to provide better online access to what's covered under their formulary," added Tarn. "It's difficult for physicians because the plans are constantly changing." Some PDA programs allow physicians to learn the exact cost of a drug, but those programs cannot, of course, tell a physician whether a patient is covered or not.
