Transcript 528-Beshir-_b

Hatem Beshir; Ahmed Kamal; Ahmed ElKhanany; Ahmed Bassiouni
Dr. Hatem Ahmed Beshir, MBBCh
Resident of Cardiothoracic Surgery
Faculty of Medicine, University of Alexandria, Egypt
1- Study Aims
2- Problem Statement
3- Methods
4- Results
5- Conclusions
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To Identify cost-reducing strategies, including Cost
related non adherence (CRN).
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To Understand how are these strategies employed by
chronically-ill patients presenting to Alexandria
University Hospitals.
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To Examine factors affecting prevalence of CRN.
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To Explore impact of better Doctor Patient Interaction
(DPI) on CRN.
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To Pinpoint the best DPI methods that minimized CRN.
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1. Heisler M, Wagner TH, Piette JD. Clinician identification of chronically ill patients who have problems paying for prescription medications. Am J Med. 2004 Jun
1;116(11):753-8
2. Atella V, Schafheutle E, Noyce P, Hassell K. Affordability of medicines and patients' cost-reducing behaviour: empirical evidence based on SUR estimates from Italy
and the UK. Appl Health Econ Health Policy. 2005;4(1):23-35.
3. Wilson IB, Schoen C, Neuman P, Strollo MK, Rogers WH, Chang H, Safran DG. Physician-patient communication about prescription medication nonadherence: a 50state study of America's seniors. J Gen Intern Med. 2007 Jan;22(1):6-12.
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http://www.who.int/entity/whosis/whostat/EN_WHS10_Full.pdf
5. Arab Republic of Egypt Central Agency for public mobilization and statistics health status report 2010. [Online].
6. Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, Hurley J, Grad R, Latimer E, Perreault R, McLeod P, Huang A, Larochelle P, Mallet L. Adverse events
associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001 Jan 24-31;285(4):421-9.
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6. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures.
Arch Intern Med. 2005 Aug 8-22;165(15):1749-55.
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Multivariate analysis using
binary Logistic regression
model revealed
Patients adopt multiple
strategies in CRN to adopt with
drug costs (given a score
according to number of
methods used).
Income Ratio :Drug cost to
monthly income ratio ,P=.003
Insurance Coverage: (P <. 001)
(Non Insured 75.9% , Public
22.4%, Private 1.7%)
Education: (P=.028) (University 14.2%
- High School 23.8% - Elementary
26.7% - No Education certificate
35.3%).
Better DPI regarding drug
costs (p = .004)
Marital status: widowed were 4
times liable than married to
develop CRN (P=.044) .
Number of medications currently
prescribed (per month) : against
higher rates of CRN (p=.003).
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Cost Reducing Strategies Adopted by our sample
Percent of Positives
Seeking Alternative Medicine
Ignoring presciption
28.50%
30.50%
Postponing Purchase till payed
Rationing
Skip Doses
Buy The most important drug
Ask for Cheaper subtitute (Generic)
Borrow money - Debt
Axe Houshold Expenses or cut on other…
55.40%
33.40%
49.20%
50.80%
45.20%
58.40%
81.50%
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Discussing Drug Costs With the
Physician
Never mentioned
Yes, Mentioned In advance by the patient
Yes, Mentioned in advance by the physician
Patients Who Discussed Drug Costs
With Physician against CRN
Never Mentioned
Yes, Mentioned in advance by the
patient
Yes, Mentioned in advance by the
physician
117
22%
73
50%
30
29%
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65
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CRN -ve patients
(n=48)
CRN +ve patients
(n=255)
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Doctor patient interaction methods to decrease CRN
Mentioned the price of the Drug
Reduced the numbers of medication prescribed
50%
30%
Gave free sample medication of the prescribed
42.90%
Changed one to cheaper alternative
42.70%
Informed how & where to get less expensive…
Mentioned which medications must not be…
Asked if the patient can afford
Showed sympathy about high drug costs
30%
50%
55%
78.00%
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Patients who did not discuss drug costs with physician
Did not have enough trust in the physician
Did not have enough time to mention it
Did not think this issue important
Thought that physician will not help
Nobody asked
Being embarrased to mention the problem
20.30%
23.30%
34.90%
47.10%
71%
75%
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Patient-physician
communication can
be an important
determinant of selfmanagement
behavior and
health outcomes
Clinicians can pay
an important role
with patients who
face problems
paying for
prescription drugs
Ensuring patient
education on drug
costs, showing
strong emotional
support and
reducing poly
pharmacy can
significantly lower
CRN
Encouraging
patients to ask for
cheaper
alternatives
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