title: Predictors of rheumatoid arthritis patient-physician communication about medication costs during visits to rheumatologists.
abstract: OBJECTIVE
  To examine the frequency with which medication costs are discussed, and the predictors of these discussions, during visits between rheumatologists and their patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Audiotapes of medical visits, patient questionnaires, medical records, and physician questionnaires were collected from March 2003 to December 2005. Data were collected from 200 RA patients from 4 rheumatology clinics. Audiotapes were coded for the presence of communication about medication costs using a detailed coding instrument. The final analysis sample included 193 patients and 8 rheumatologists. Stepwise multivariable logistic regression was used to examine the role of patient, physician, medication, and relationship characteristics on discussions of medication costs.
  
  
  RESULTS
  Despite medication changes being made in more than 50% of the visits, only 34% of those visits included discussions of medication-related costs; 48% of these discussions were initiated by patients. In multivariable logistic regression models, communication about medication costs occurred more often when patients were white (compared with nonwhite) and reported an annual income of $20,000-$59,999 (compared with those earning > or =$60,000). Discussions about medication costs also were more common when physicians were white.
  
  
  CONCLUSIONS
  Although medication changes were common, medication costs were only discussed in one-third of the visits. Communication about medication costs was more common among patients who were white and in a middle income category. Disparities in communication about medication costs have the potential to negatively impact prescribing and subsequent medication use. Further research should examine potential disparities in communication about medication costs.
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA. Ashley_Beard@hphc.org
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Beard
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Blalock
authors.forename: Mary
authors.initials: M
authors.lastname: Roth
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Gail
authors.initials: G
authors.lastname: Tudor
authors.forename: Betty
authors.initials: B
authors.lastname: Chewning
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D003142:Communication; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000191:economics; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011306:Prescription Fees; D012219:Rheumatology / Q000191:economics