title: Clinician identification of chronically ill patients who have problems paying for prescription medications.
abstract: OBJECTIVE
  Little is known about whether health care providers are effectively identifying patients who have difficulty covering the costs of out-of-pocket prescription medications. We examined whether and how providers are identifying chronically ill adults who have potential problems paying for prescription medications.
  
  
  METHODS
  We conducted a cross-sectional survey of a national sample of 4050 adults aged 50 years or older who use prescription medications for at least one of five chronic health conditions. The primary outcome measure was patient report of being asked by a doctor or nurse in the prior 12 months whether the patient could afford the prescribed medication. The measures of prescription cost burden were cost-related underuse of medications, cutting back on other necessities to pay for medications, and worries about medication costs. We adjusted for patient income, education, race/ethnicity, age, sex, health status, number of prescribed medications, pharmacy benefits, frequency of outpatient visits, having a regular health care provider, and sampling weights.
  
  
  RESULTS
  In the weighted analyses, 16% (547/4050) of respondents reported that they had been asked about potential problems paying for a prescribed medication. Only 360 (24%) of the 1499 respondents who reported one or more burdens from out-of-pocket medication costs reported being asked this question. After adjusting for potential confounders, patients who had cut back on medication use or other necessities to cover payments were no more likely than other patients to be asked about the ability to pay for prescription medications. Concerns about medication costs, being a racial/ethnic minority, taking seven or more prescription medications, and having no prescription coverage were independently associated with a greater likelihood of being asked about possible problems with prescription costs.
  
  
  CONCLUSIONS
  Few chronically ill patients who are at risk of or experiencing problems related to prescription medication costs report that their clinicians had asked them about possible medication payment difficulties.
authors.affiliation: Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48113-0170, USA. mheisler@umich.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010819:Physician's Role; D012959:Socioeconomic Factors; D014481:United States