Medication affordability discussions with older adults in primary care
Exploratory Research in Clinical and Social Pharmacy
Conversation, Cost, Elderly, Medication, Primary care
Introduction: Cost is a major barrier to medication accessibility. While a minority of adults experience problems affording their medications, older adults are particularly vulnerable due to increased polypharmacy and fixed incomes. Clinicians can help reduce cost-related non-adherence and improve medication affordability; however, opportunities to improve affordability are often missed due to failure of the patient or clinician to discuss the issue. Objective: Identify the incidence and resolution of cost-related conversations between patients and clinicians during primary care visits. Methods: We conducted this quality improvement project at a primary care office. Student pharmacists observed in-person encounters with patients ≥65 years of age and documented the incidence of cost-related conversations and who initiated the conversation. After the visit, they asked if the patient had affordability issues. Patients and clinicians were blinded to the study purpose and hypothesis. Results: Students observed 79 primary care visits. Cost conversations (medication or non-medication related) occurred in 37% (29/79) of visits. Having concerns about affordability did not impact the likelihood of conversation about non-medication related healthcare costs (RR = 1.21 95% CI 0.35–4.19, p = 0.67) or medication related costs (RR = 0.86 95% CI 0.13–5.65, p = 1.0). Conclusion: Our results indicated that cost conversations did not routinely occur at our site. Failure to discuss costs, especially for patients with underlying cost concerns, may lead to cost related non-adherence and worse outcomes.
Rightnour, J., Baird, J., Benjamin, K., Qing, M., Gionfriddo, M., McConaha, J., & Schoen, R. (2023). Medication affordability discussions with older adults in primary care. Exploratory Research in Clinical and Social Pharmacy, 9. https://doi.org/10.1016/j.rcsop.2023.100230