Rx Costs: Doctors Don’t Ask, Patients Don’t Tell
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John Piette and Michele Heisler
Photo: Martin Vloet |
Millions of Americans struggle every day to pay for prescription medicines,
often cutting back on how often they buy or take drugs to save money. According
to new studies by U-M and Veterans Administration researchers, many of the sickest
of these patients don’t tell their doctors what they’re doing — even though skimping on medication could harm their health.
“Chronically ill patients are the ones who most need these medications.
Yet their doctors don’t know they aren’t taking them as prescribed,”
says John Piette, Ph.D., associate professor of internal medicine in the U-M
Medical School and a scientist at the VA Ann Arbor Healthcare System. “As
drug costs and the number of chronically ill Americans continue to rise, it’s
essential that health care providers proactively discuss costs and schedule
adherence with their patients.”
Piette co-authored a study, published in the Archives of Internal Medicine,
which found that two-thirds of 660 chronically ill patients with at least one
serious medical problem, who cut back on their prescription drugs to save money,
didn’t tell their doctors before they started skipping doses or refills.
Two-thirds of the patients said no one on their medical team asked if they
were having trouble paying for their drugs. More than half thought their doctors
and nurses would not be able to help, and nearly half were embarrassed to raise
the issue or didn’t think it was important.
Michele Heisler, M.D., a research scientist at the VA Ann Arbor Healthcare
System and a lecturer in the U-M Medical School, was a co-author on the study.
She maintains the findings reinforce how critical it is for doctors and nurses
to take the initiative by asking patients if they’re having trouble paying
for their drugs and educating them about which ones are most necessary to protect
their health. The researchers found that most patients who did speak up got
help through free samples, generic drugs or information about assistance programs.
Piette and Heisler recently published results from another study documenting
long-term poor health consequences in people who reported cutting back on their
medications due to cost.
“The bottom line for patients is: speak up or you might miss a great
chance to get help. Don’t wait for your doctor to ask if you’re
having problems paying for medications,” says Piette. “And the bottom
line for doctors and nurses is: don’t be shy about asking patients if
they can afford the drugs you’re prescribing, educating them about the
importance of sticking to the ones that can help them most, and encouraging
patients to speak up if they have trouble paying down the road.”
—KG
For more information on both studies:
www.med.umich.edu/opm/newspage/2004/medcost.htm
www.med.umich.edu/opm/newspage/2004/moneyorhealth.htm
 
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